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Breast Cancer Research in the
Developing World
Dr. Steven Narod
Canada Research Chair in Breast Cancer
Boston – November 2009
Annual numbers of breast cancers

Top 10 countries

China
224,000

USA
195,000

India
113,000

Germany
53,000

Russia
52,000

Italy
38,000

Brazil
38,000

France
38,000

United Kingdom
36,000

Indonesia
28,000
Breast Cancer Cases by Continent







Asia
South America
Africa
Central America
508
82
69
18
(677)
North America
Europe
Australia
213
324
11
(548)
By Stage of Development

Developing
739

Developed
486
(IMF)
Why do research in developing
world?

Major cause of death in those countries

Most breast cancers occur in developing world

Rates may be increasing

Populations aging

Better understanding of variation in patterns, etiology

Might lead to understanding in North America

Different stage at presentation

Might be specific etiology for other ethnic groups

Planning of services

Milestones
Examples

Advanced cancers:


Different than North America
From stage 4 to death

Metastastic oophorectomy/tamoxifen

New drugs

(Raises ethical issues)
Questions about Etiology

Recessive genes

Different diets

Different environmental exposures
Towards a Standard Set of
Descriptors

Population or hospital-based

Private or Public

Prevalent or incident cases

One year of diagnosis, several year of
diagnosis
Variables to Collect

Age of diagnosis

Means of detection patient, physician, mammography

Size
Nodes examined
Nodes positive
Locally advanced
Clinical Stage Grouping (early, locally advanced, metastatic)








ER
PR
HER2
Grade
Variables to Collect, cont….
o
o
o
o
Treatment
Radiotherapy (y/n)
Chemotherapy
Regimen
o
o
o
o
o
o
o
o
o
o
o
Hormonal therapy
Oophorectomy
Age of oophorectomy
Tamoxifen
Aromatase inhibitors
Menopausal status at diagnosis
Age of menopause
o Date of last follow-up
o Date of Death
o Cause of Death
Surgery
Mastectomy
Lumpectomy
Bilateral mastectomy
Questions to address

Are people getting appropriate
treatment?

Is stage at presentation improving?

Is treatment effective?
Western model applied to
developing countries

Promotes two-tiered system

May not be best approach for
population


Access and affordability
All populations may not respond the
same
Possible recessive basis for breast
cancer

Test of recessive disease, parents related

Test in children of consanguinous parents

Homozygosity mapping

Countries with high rates of consanguinity:
Pakistan
Bangladesh
Yemen
Saudi Arabia




Risk Factors May Differ

Vietnam: 300 cases and 300 hospital
controls
No effect of family history
 No effect of parity
 Very low frequency of BRCA1 and
BRCA2


Different risk factors?
Hypothesis

There are no common risk factors for
breast cancer.