Burden of Breast Cancer as a Non-Communicable Disease: Global and National Trends, Modifiable Risk Factors, and Key Policies in Australia and Internationally

Breast cancer is the most common cancer among women globally, and its incidence is expected to rise further due to lifestyle changes. Lack of awareness among patients and general practitioners, fear of side-effects, and issues concerning licensing and indemnity are the main barriers to reducing the disease burden. Modifiable risk factors such as alcohol intake, excess body weight, high BMI, and lack of physical activity can increase the risk of breast cancer in post-menopausal women. Key policies in Australia and internationally focus on early detection, prevention measures, and promotion of use of preventive therapy with drugs such as tamoxifen in high-risk individuals.

Non-communicable diseases-
breast cancer

Burden of disease global
• The burden of cancer as a non-communicable disease has
been growing globally. It has moved from being the third
largest cause of death to being the second largest cause of
death and is second only to cardiovascular disease.
• Breast cancer is the most cancer among women and in
2013, incidence of breast cancer was reported in1.8
million women. 13.1million women across the globe had
to undergo mastectomy due and were affected by
disability adjusted life years (DALYs).
• The higher incidence of breast cancer has been attributed
to the increase in life expectancy in the developed and the
developing countries.

Burden of disease global
• As more aged people populate the globe the incidence of cancer is
expected to rise further. Lifestyle changes are a significant cause for
the increase. Obesity and smoking have increased the risk of cancer.
• A 16.61% increase in the incidence of cancer has occurred from1990
to 2013.. And the overall increase in deaths due to all cancers has
risen from 12% to 15% from 1990 to 2013 (Collaboration., 2015).
Globally, one in18 women develops breast cancer.
• There is a vast difference between the developed and the
developing countries with regard to access to treatment and the
subsequent outcomes for their people vary accordingly
(Collaboration, 2017).

Burden of disease-national trends
• One in eight women in Australia develop breast
cancer before the age of 85. Improved diagnosis
and advanced treatments have increased the
survival rates of patients diagnosed with breast
cancer. So it is likely that the coming years will see a
higher incidence of breast cancer and better
survival rates (Yu, et al., 2014).
• Out of 16,045 cases of cancer in 2013, mortality
due to breast cancer in Australia was 2844 (aihw).

Barriers to reducing disease burden
• Reduction of disease burden in case of cancer is
possible by adopting preventive measures.
• The main barriers in making use of preventive
therapy are
• Lack of awareness among patients with high risk of
cancer.
• Lack of awareness among general practitioners
• In case of use of chemo-preventive drugs, such as,
tamoxifen raloxifene, exemestane, and anastrozole,
there is a fear of side-effects (DeCensi, 2015).

Barriers to reducing disease burden
• Issues concerning licensing and indemnity also deter the use of
preventive therapy
• There exists an imbalance between preventive and therapeutic
research that needs correction.
• A 30% reduction in the disease burden due to cancer can be
achieved by bringing the risk down to 50% in high risk
individuals. While screening and early detection are regarded as
favourable ways to cut disease burden, the use of therapy for
prevention and its success are largely ignored, even within the
medical profession.
• A strategy for prevention based on diet and lifestyle is also
successful, if followed by people in the high risk category
(DeCensi, 2015).

Modifiable risk factors
• Reducing cancer incidence and decreasing disease
burden is a major public health priority. The risk
factors that increase the chances of cancer are well
understood. If population wide measures are taken
to modify the risk factors, incidence of cancer can
be prevented. The severity of the disease and the
cost of treatment should be sufficient deterrants
and encourage making life style changes apriority
for individuals and policy makers alike.

Modifiable risk factors
• Intake of alcohol, excess body weight, high
BMI, and lack of physical activity are
important factors that increase the risk of
breast cancer in post menopausal women. But
all these are factors that can be modified. The
fact that needs reiteration is that these factors
can be modified with much greater ease than
the difficulties associated with occurrence of
breast cancer.

Key policies in Australia
• Several policy efforts in cancer prevention,
screening, treatment, and palliation are currently
being made in Australia.
• One of the key policies in Australia has been the
involvement of the general practitioner in educating
patients about preventive steps to reduce the
modifiable risks of breast cancer
• General practitioners can play n important role in
the early detection and screening for cancer

Key policies in Australia
• Early detection is often the key and requires lesser
treatment and higher chances of success with
treatment because it has not metastasised and is
therefore more amenable to treatment
• General practitioners can make early referrals to the
oncologists possible if they find symptoms in patients
• They can educate patients, so that they are aware
about self examination, importance of early
detection and palliative care (McAvoy, 2007).

Key international policies
• The WHO recommends mammography of all women in order
to facilitate early detection, because early detection is often
the key to survival.
• The WHO also recommends that prevention measures be
adopted, so that cancer does not occur and its incidence can
be controlled.
• Maintaining a healthy lifestyle through consumption of a
healthy diet.
• Regular physical activity and control over intake of alcohol are
measures that can effectively prevent breast cancer. Prevention
of obesity or high BMI among post-menopausal women is an
effective way to prevent breast cancer (WHO, n.d.).

Key international policies
• Engagement of policy makers is required for
promotion of use of preventive therapy with drugs
such as, tamoxifen in high risk individuals.
• Research involving improvement in existing
biomarkers and finding new biomarkers for cancer
prevention should receive a boost through better
funding.
• An example is detection of circulating tumor-DNA for
prediction of cancer in high risk patients (Mäbert, et
al., 2014)

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