While a cure has not yet been found, public perception surrounding breast cancer has changed dramatically. Once a disease that women felt ashamed to discuss, breast cancer now has lost much of its stigma, providing the opportunity for politicians and healthcare officials to acknowledge that economic and political considerations bear on the success of breast cancer treatment as much as advances in medical science.
Breast carcinoma is among the most frequent malignant diseases in the world and is the leading cause of death among younger women in developed countries. Currently, 1 in 7 woman in these countries will have the disease in their lifetime (Boyle and Ferlay). Since 1940, the incidence of breast carcinoma has gradually increased at a rate of approximately 1 per cent per year in Western countries (Harris et al.). On the other hand, mortality from breast cancer has declined in countries with organised population-based mammography screening (Smith et al. 2004).
New efficient therapeutic regimes have led to prolonged survival of patients with improved quality of life (Hortobagyi). These interventions have considerably increased the number of breast cancer survivors, and a further increase of 31 per cent is expected from 2005 to 2015 (De Angelis et al.).
Screening, diagnosis, and treatment will place an ever growing burden on the healthcare system, in addition to the psycho-social consequences for the women of coming generations. Obviously, a paradigm shift in understanding the natural history of breast carcinoma is needed to develop new and more efficient preventive, diagnostic, and therapeutic alternatives and break the negative trend.
Mortality rates have declined in all age groups since the late 1980s (Figure 1). Between 1989 and 2008, the breast cancer mortality rate fell by 44 per cent in women aged 40-49 years; by 44 per cent in women aged 50-64; by 37 per cent in women aged 65-69; by 39 per cent in women aged 15-39; and by 19 per cent in women over 70. Two major reasons have been attributed to this decline: increased use of screening mammography and greater use and improvements of adjuvant therapies such as hormonal and chemo-therapeutic agents. In UK, breast cancer is the most common cancer accounting for 31 per cent of all cases in women; the next most common cancer in women is lung cancer. So nearly a third of all new cancers in women are breast cancers. It has been estimated that the lifetime risk of developing breast cancer in 2008 is 1 in 1,014 for men and 1 in 8 for women in the UK.
A recent retrospective analysis in UAE showed that breast cancer risk is related to age, with 35 per cent of cases occurring in women aged 40 years and over. Nearly 24 per cent of cases of breast cancer are diagnosed in the 50-69 age groups (Figure 2). According to the World Health Organisation, the occurrence of breast cancer ranks number 1 in most Arabic countries (Table 1). An increase of more than 50 per cent of breast cancer cases has been seen in UAE over the past decade.
Surgery
