CANCER GENETICS The most well publicised breast cancer gene, and the one associated with the highest risk of developing the disease, is BRCA1. Another gene -BRCA2 - causes a significantly increased risk as well. All people have these genes; only when humans inherit certain mutated forms do their breast cancer risk increase. According to the American Cancer Society (2009), women who inherit the mutated version of BRCA1 or BRCA2 have a 57 or 49% chance, respectively, of developing breast cancer by age 70. Fortunately, less than 1% of the world population carries the harmful versions of these breast cancer genes. It was in the 1990’s, when Mary Claire


King localised the BRCA-1 gene for inherited susceptibility to breast cancer to a specific site on chromosome 17. The BRCA-1 gene was ultimately cloned in 1994. King demonstrated that a single gene on chromosome 17, later known as BRCA1, was responsible for many breast and ovarian cancers - as many as 5-10% of all cases of breast cancer may be hereditary. The identification of two tumour suppressors’ genes BRCA-1 and BCRA- 2 has provided great insights into the understanding of breast cancer genetics.


NEW HOPE FOR THE 21ST CENTURY Breast cancer is by far the most frequent cancer among women with an estimated 1.38 million new cancer cases diagnosed in 2008 (23% of all cancers), and ranks second overall (10.9% of all cancers). It is now the most common cancer both in developed and developing regions with around 690,000 new cases estimated in each region. Current worldwide breast cancer age-standardized mortality rates is 14.1 per 100,000 population in 2008; while in UAE it is estimated at 10.9/100,000 new cases diagnosed per year and an estimated 75 deaths. With the decline of the Halsted


radical mastectomy and a revised theory of metastases, physicians hypothesized about the origins of breast cancer and, during the 1990s, everything ranging from diet, chemical pollution, race, delay in having children, and breastfeeding was up for debate. Recent research has also shown that obesity may increase the risk of developing breast cancer as well.


Figure 1: Age-standardised (European) mortality rates, breast cancer, females, UK


45 40 35 30 25 20 15 10 5 0


Year of death


Figure 2: Age-specific mortality rates, breast cancer, females, UK, 1971-2008 15-39


100 150 200 250


50 0 Year of death


Despite this uncertainty, there were still advances in the treatments for breast cancer. Up until 1995, the breast cancer rates and deaths were high and then started to decline. The improvements in chemotherapy, radiation, hormonal treatments, mammography, and surgery helped move breast cancer from an urgent disease to a chronic condition. Today, advances in molecular and genetic sciences are creating novel therapeutic strategies that give women not only hope but also more choices about their bodies. There are some studies as well in their initial stage towards creating an anti breast cancer vaccine. The breast cancer disease is


so complex, diverse, and so subtly connected to genetic and environmental variables that finding a cure can often seem impossible. 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 health care officials to acknowledge that economic and political considerations bear on the success of breast cancer treatment as much as advances in medical science. ■


AH


REFERENCES References available on request (magazine@informa.com)


Learn more The CME accredited Breast Cancer Conference will take place on 1-2 April 2012. The conference will cover topics such as surgery, ‘The Middle East Experience’, new advances in treatment and management, plastic surgery and ‘The patient journey’. To find out more and to book your place, visit the website www.obs-gyne.com


Arab Health OBS/GYNE 2012 17 40-49 50-64 65-69 70+


Rate per 100,000 women 1971


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1971 1974 1977 1980


1983 1986 1989 1992 1995 1998 2001 2004 2007


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