Here is what the query I sent around the world: I just want to pose a question to my contacts from the various world conferences on breast cancer. Listening to the women from developing nations describe the increase in incidence of breast cancer in their countries has made me think about risk factors. In the developed nations, particularly the United States, we are told that early menarche, late or no childbearing, no breastfeeding and obesity or weight gain are "risk' factors. Yet the women from developing nations have stated that their populations do not start menstruating until about age 13, they are thin (sometimes malnourished), bear about 5 children on average and breastfeed ALL of them. So what does this say about what we all regard as risk factors? I think they need to be reconsidered and I welcome a dialogue about this. Please send your comments to me. From a New Yorker: As far as the risk factors go. Breast cancer is so many different diseases what causes it in an African could be different than here. Especially with the age difference. For example,we might have too high levels of circulating estrogens and theirs might be too low. Or maybe theirs is from pesticides and ours is from a virus or vice versa or any combination of these factors. I think the main thing that make our "risk factors" questionable is that they include many women who will never get breast cancer. Zeneca's (makers of Tamoxifen) figure of high risk is 29 million and that is about 40% of the female population over 35 years old (I think). And about 60-70% of the women who get breast cancer won't be in that 29 million. Another New Yorker: We know that "risk" doesn't mean "for sure". I'd still like to know what percentage of women in the poplulations do get cancer. It may be impossible to tell, but we know even in our own country that women get B.C. even if they don't fit those profiles. We also know the importance of early diagnosis and that many women don't have access to good medical facilities and so don't try to get help since diagnosis and treatment are two different things. Also, if we talk about mortality, I sometimes think that it's the roll of the dice. An American woman: It could be that in Africa there arevproportionally more women with unknown risk factors. OR... they have risk factors that are different to ours and so we don't'know' them. I in fact had no know risk factors at all..... It's a lottery I think sometimes. From a woman in Mississippi If developing nations are finding an increase in breast cancer, could it be related to environmental aspects brought in by other nations, such as pesticides? Another New Yorker: I fall into the category of women at risk due to early menses, no full term pregnancy's, being overweight, etc. However, my thoughts about women in developing nations may have more exposure to carcinogens and their diets may be poor. Could this be a contributory factor? Another respondent: It is not as simple as you mentioned that risk factors can be listed. I am a radiologist working in the field of mammography since 10 years......and in my opinion we have to consider other risk factors such as computers sun at beaches T.V ,and type of food...... I will be happy if you ask me specific questions that I can answer. A surgeon from The Netherlands: I believe figures of incidence are a relative matter. Since people in developing nations are -slowly but certainly- getting better access to medical care and facilities, they will die of other, better controllable, causes less frequently. Therefore, incidence of the more 'western' kinds of leading death causes, will indeed increase. Furtheremore, as people tend to get older, which is the case among the developing nations excluding those where AIDS is endemic and starting to become leading cause of death, they have survived diarrhoe, child endemic diseases, infections and the lot. So, climbing of the years adds up damage to the cells, contributing to cancer, and not only breast cancer, as a whole. Last, people in developing countries tend towards assimilating in a more 'western' lifestyle. As we know from people immigrating, immigrants take up on incidence of there new country within one generation, adopting the morbidity and mortality statistics of their new homeland. Why then, should this not be the case inside the developing countries, since they are indeed developing towards a, not necessarily more protective, western lifestyle ? It would therefore be interesting to see if cancer statistics for all variants, including lung and coloncarcinoma are climbing as well. Provided former hypotheses are correct, that should almost invariable be the case. A woman in Virginia: I know that women in developing countries do suffer high incidence of cervical cancer --lack of hygiene, screening etc. But with b/c I just don't know any more than the obvious which is that changes in their diets seem to correlate with higher incidence. I would also look to environmental factors like carcinogens in the water supply--I believe this is a huge problem in some parts of India. I really think you have to disaggregate the variables very discretely in order to get at the answer. (Just like we need much more discrete info on who is helped and hurt by various treatments...) A woman from Copenhagen: Thank you very much for your mail on breast cancer risk factors. I totally agree with you that the logic re estrogen, early menarche, length of menstruation, child birth nursing etc. is strange. First we must realize that a STATISTICAL risk factor does not necessarily indicate a cause and effect relationship. It only means that there are factors that co-vary. The term RISK factor is not necessarily an explanatory and causing factor. The causing factor(s) behind it all is hidden. As for an increasing incidence of breast cancer in developing nations. Is there scientific evidence that this is the case? Are there scientific data available comparing the incidence now and 5 - 10 - 15 - 20 years ago? I doubt it. As for the estrogen hypothesis: As estrogen decreases with age it is strange that most breast cancers develop in older women. This would point to estrogen as a MINOR risk factor. All the cells in a woman's body is exposed to estrogen and those of us who are climateric know what it is like when estrogen drops. Wrinkling skin, osteoporosis and a dry vigina are some of signs of a low estrogen. Estrogen is a cell promoter, which means that estrogen can make cells grow. There are other homones that can make cells grow like noradrenalin and adrenaline and many more. These other substances have not attracted much attention in relation to explaining breast cancer. It is no wonder that there are estrogen receptors on breast cancer cells, since the breast cancer cells originate from breast cells that are affected by estrogen. When we take an antiestrogen the hormonal environment generally of the cells of the body is changed and the cells must therefore adapt to this. Possible present cancer cells must also adapt, and since they are generally slower at adaption, antiestrogens seem to be effective supppressing breat cancer for a number of years. I think that other substances that change the hormonal enviromnent might be effective as well. There has been a lot of focus on estrogen as the big evil thing in breast cancer. But one might as well suggest that there is something wrong about being a woman and that being a woman is a risk factor for breast cancer. Denmark, has one of the highest incidences of breast cancer and this incidence is increasing. It has also been shown here that the higher social layers have a higher incidence than the lower social layers. Women working in professions seem to be more more exposed to breast cancer. So longstanding high levels of mental stress might be a more important risk factor than etrogen? Who knows. The estrogen hypothesis needs to be discussed. This is my contribution. Another New Yorker: I think a lot of the explainations about breast cancer are "blame the woman". AKA You are female ( you bleed, you have babies & you breastfeed ) -- therefore, you have breast cancer. This is to obscure the increasing incidences of pollutants & toxins in our air, water & soil which are the real staging grounds for our increasing & collective responses. I have lived most of my life in Staten Island, which is an acknowledged "cancer alley" with pollutants blowing their way up the eastern seaboard from as far away as Ohio (documented by Congressman Molinari before Congress). There is also a massive toxic waste dump here, right by the Staten Island Mall. It is a matter of record that the families who bought homes in that area have suffered an abnormally high count & variety of cancers, tragically including pediatric cancers. I also attribute my brush with cancer to high stress - on the job & at home. I have had to learn to calm down & walk away from stuff. My family, on my father's side, lost many members to cancer. They all lived in Brooklyn over 50 years ago; 1st generation American of Irish origin. But I am the first woman in my family known to have had bc. I'd say that I fit most of the profile "they" give: "late or no childbearing, no breastfeeding and weight gain", but I also know of several women in my community, who died of bc -- who were slim, had had children, breastfed, etc.. Looking at that, I am inclined to weigh the toxic environment over the chromosomal profiling. Sad to say, the local hospitals are doing a booming business in Radiology -- they have expanded their facilities & their operating hours to accomodate all the people, male & female, who need treatment. The body casts are for adults of all ages, & they're stacked up in the treatment rooms & out in the halls. The US has legislated against many harmful pesticides, but United Fruit & other corporations are active in countries where no such laws exist to protect produce for either the domestic or export markets. The same applies to manufacturing processes, etc. Where we are looking at numbers of reported cases going up around the world, I think we have to look at the industrial wastage toxins being released into the environment. It more than just a "change in diet". A researcher from New Zealand: It is vital that we reliably identify risk factors for breast cancer. Many will be personal and lifestyle and many will be environmental. They are likely to differ from community to community, and country to country. Good personal strategies and sound city, state, province, regional and national policy requires sound and reliable analysis. A key point though, is that conflict must arise between the producers of environmental toxins and officials and politicians. The producers will do all they can to delay identification of their products and risk factors. I am seeking to use my position (as an elected regional councillor and the policy chair of our council, as well as an environmental scientist, to initiate a debate in New Zealand to attempt to gain support from other policy chairs of the other 15 regional councils, for a summit of leaders to establish an analysis and research agenda to identify the breast cancer risk factors region by region and nationwide. Every country has different structures and situations. If we can all do some things and report to each other about successes and failures, then our network will grow and strengthen all of our efforts. This is no place for egos but a place for hard work and personal risk. Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.