Breast cancer - UK incidence statistics

Breast cancer has been the most common cancer in the UK since 1997, despite the fact that it is rare in men. It is by far the most common cancer among women in the UK, accounting for 31% all new cases of cancer in females.1-4

In 2009, there were 48,788 new cases of breast cancer in the UK (Table 1.1): 48,417 in women and 371 (less than 1%) in men, giving a female:male ratio of around 131:1.1-4

European age-standardised incidence rates (AS rates) do not differ significantly between the constituent countries of the UK (Table 1.1); however, the lowest rates are recorded in Northern Ireland, and this has been a consistent pattern for almost two decades.5 Scotland is the only nation in the UK where breast cancer is not the most common cancer overall; there lung cancer is more common.1-4 An analysis of female breast cancer incidence rates throughout the UK in 2005 reported only modest variation between cancer networks.6

Table 1.1: Breast Cancer (C50), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2009

*95% LCL and 95% UCL are the 95% lower and upper confidence limits around the AS Rate

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Please note: In the following six sections, data are for female invasive breast cancer only. Data on female in situ breast carcinoma, and on invasive breast cancer in males, are given in the last two sections on this page.

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Female breast cancer incidence is strongly related to age, with the highest incidence rates overall being in older women, supporting a link with hormonal status. In the UK between 2007 and 2009, 45% of cases were diagnosed in women aged 65 and over, and 81% were diagnosed in the 50s and over (Figure 1.1).1-4 Age-specific incidence rates rise steeply from around age 35-39, level off for women in their 50s, then rise further to age 65-69, drop slightly for women aged 70-74, then increase steadily to reach an overall peak in the 85+ age group.1-4 The peaks and troughs of incidence for women aged 50 and over may reflect the impact of the national screening programme.

Figure 1.1: Breast Cancer (C50), Average Number of New Cases per Year and Age-Specific Incidence Rates, Females, UK, 2007-2009

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Nearly half (48%) of female breast cancer cases are diagnosed in the 50-69 age group (Figure 1.1);1-4 currently women in this age group and those aged 70 are invited to attend the UK national screening programmes. The NHS Breast Screening Programme in England is starting to extend routine invitations to women aged 47-73; this extension (which is being carried out as a randomised trial) is due to be completed by 2016. You can read more about breast screening here.

Although very few cases of breast cancer occur in women in their teens or early 20s, breast cancer is the most commonly diagnosed cancer in women under 39. Among women aged 35-39 more than 1,350 cases of breast cancer are diagnosed each year.

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Female breast cancer European AS incidence rates increased by 69% overall between 1975-1977 and 2007-2009 in Britain (Figure 1.2).1-3 Incidence rates initially increased steadily by around 1-2% per annum from the mid-1970s.5 The introduction of national screening programmes in 1988 led to a transient additional increase in incidence as a prevalent pool of undiagnosed cancers were detected in the population. By the mid-1990s, the increase in incidence rates returned to the pre-screening pace and continued this way until the mid-2000s, after which time incidence rates have remained relatively stable (Figure 1.2).1-3

Figure 1.2: Breast Cancer (C50), European Age-Standardised Incidence Rates, Females, Great Britain, 1975-2009

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Female breast cancer incidence trends for the UK are shown in Figure 1.3.1-4 Over the last decade (between 1998-2000 and 2007-2009), the European AS incidence rate increased by 6%, with almost this entire rise occurring before the mid-2000s.

Figure 1.3: Breast Cancer (C50), European Age-Standardised Incidence Rates, Females, UK, 1993-2009

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Overall, female breast cancer incidence rates have increased for all age groups in Britain over the last 40 years, though the trends by age-group show clearly that the steeper increase in incidence in the late 1980s and early 1990s was largely confined to women aged 50-64 who were invited to join the breast screening programme at that time (Figure 1.4).1-3 The most recent rates show a slight downturn for this age-group. Similarly, the recent steep rise in rates for women aged 65-69 is almost certainly caused by the extension of the breast screening programme to include this age group, which started in 2001 (Figure 1.4).1-3

Figure 1.4: Breast Cancer (C50), European Age-Standardised Incidence Rates, Females, by Age, Great Britain, 1975-2009

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The trends in breast cancer incidence are most likely to be associated with the declining use of hormone replacement therapy (HRT), which has been shown to increase the risk of breast cancer in some women.7,8

A similar steep decrease in incidence was seen since 2002 for women aged 50 or older in the USA. This was linked to the sudden drop in HRT use following publication of the Women's Health Initiative (WHI) Trial results. 9-12 The WHI trial was a randomised controlled trial of oestrogen-plus-progestin use in post-menopausal women for prevention of chronic disease. The trial was stopped early in July 2002 because risks exceeded benefits. The most recent WHI study reports that the decrease in breast cancer incidence in the over 50s is most likely to be due to the reduced use of HRT rather than decreased uptake of screening and also that the risk of breast cancer after stopping HRT seems to fall very quickly.13

Similar trends have been seen in other countries.14 In Scotland an analysis of breast cancer incidence and HRT use also reports a reduction in incidence for women aged 50-64 and a dramatic decrease in HRT use consistent with this theory (Figure 1.5).15 This analysis also showed a gradual increase since 1999 in prescriptions of raloxifene - a selective oestrogen receptor modulator that has been shown to reduce risk of oestrogen-receptor-positive breast cancer and is also used to treat osteoporosis.16

Rates of HRT use in the UK rose steeply from 1992 to peak in 2000-2001, with approximately 25% of women aged 45-69 using HRT; by 2006, this percentage had halved.17 It has been estimated that 1,400 fewer cases of breast cancer were diagnosed in women aged 50-59 in the UK in 2005 than would have occurred if HRT use had not declined.17

Figure 1.5: European Age-Standardised Incidence Rates of Invasive Breast Cancer, by Age Group, in Scottish Women (1980-2005)  and numbers of dispensed items of HRT and Raloxifene (1993-2005)

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The lifetime risk of developing breast cancer in the UK is estimated to be 1 in 8 for women (calculated using 2008 data).18

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Although cancer registration has a long history in many countries of the world, particularly in the more affluent regions such as the UK, nearly 80% of the world’s populations live in regions that are not covered by such systems.19 Nonetheless, with a view to characterising the global burden of the disease, the International Agency for Research on Cancer routinely uses the available data to estimate worldwide cancer incidence.20

Breast cancer is by far the most common cancer diagnosed in women worldwide, with an estimated 1.38 million new female breast cancer cases diagnosed in 2008 (around 23% of the total in women only, and around 11% of the total in men and women together). Breast cancer incidence rates are highest in Western Europe and lowest in Eastern and Middle Africa, with nearly five-fold variation in World AS incidence rates between the regions of the world (Figure 1.6).20

Figure 1.6: Breast Cancer (C50), World Age-Standardised Incidence Rates, Females, World Regions, 2008 Estimates

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Within the 27 countries of the European Union, the highest female breast cancer European AS incidence rates for 2008 are estimated to be in Belgium (around 145 cases per 100,000), while the lowest rates are in Greece (around 57 cases per 100,000) (Figure 1.7). UK female breast cancer incidence rates are estimated to be the 6th highest in Europe (EU-27).21

Figure 1.7: Breast Cancer (C50), European Age-Standardised Incidence Rates, Females, EU27 Countries, 2008 Estimates

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Female breast cancer incidence has been increasing for many years in economically developed regions of the world;9,22 and now rates in central and eastern Europe and the Far East, which have historically been comparatively low, have begun to rise rapidly.23-25 These increases have been linked to lifestyle changes, for example in reproductive behaviour, weight gain, alcohol consumption and the use of HRT.26 Accordingly, in populations of women who migrate from low to high risk countries breast cancer rates typically increase rapidly to reach those of the local population, suggesting a strong effect for lifestyle or environmental factors.27,28

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Female breast cancer incidence is strongly related to deprivation; it is one of the few cancers where incidence rates are lower for more deprived women and there is a clear trend of decreasing rates from least to most deprived women.29 The most recent England-wide data for 2000-2004 shows European AS incidence rates are around 25% higher for women living in the least deprived areas compared with the most deprived;30 in this time period there would have been an additional 2,500 new breast cancer cases each year in England if all women experienced the rates of the most affluent.30

A study in Scotland for 2005-2009 showed that breast cancer incidence is around 11% higher for the least deprived women compared with the most deprived.31 Clear associations with deprivation have also been reported in Wales and Northern Ireland.32,33

These results are not unexpected as many breast cancer risk factors – for example, late first pregnancy, lower parity, and HRT use – are generally more prevalent in more affluent populations.34

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Prevalence refers to the number of people who have previously received a diagnosis of cancer and who are still alive at a given time point. Some patients will have been cured of their disease and others will not. The latest estimates for the UK (Table 1.2) show that around 296,000 women were still alive at the end of 2006, up to ten years after being diagnosed with breast cancer.35 Worldwide, it is estimated that there were around 5.2 million female breast cancer patients still alive in 2008, up to five years after their diagnosis.20

Table 1.2: Breast Cancer (C50) Prevalence in the UK, at 31st December 2006

The latest estimates for the UK (Table 1.2) show that around 1,700 men were still alive at the end of 2006, up to ten years after being diagnosed with breast cancer.35

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In 2009, 371 men were diagnosed with breast cancer in the UK (Table 1.1). Among men, breast cancer is the 26th most common cancer, accounting for less than 1% of male cancer cases.

Breast cancer incidence in males is strongly related to age. In the UK between 2007 and 2009, around 65% of male breast cancer cases were in men aged 65 years and over (Figure 1.8).1-3

Figure 1.8: Breast Cancer (C50), Average Number of New Cases per Year and Age-Specific Incidence Rates, Males, UK, 2007-2009

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Breast cancer incidence rates for men have changed very little since the late 1970s in Britain (Figure 1.9).1-3

Figure 1.9: Breast Cancer (C50), European Age-Standardised Incidence Rates, Males, Great Britain, 1979-2009

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Some tumours detected in the breast are non-invasive; these are called in situ breast carcinoma (ICD-10 D05). The natural history of these tumours is not fully known but there is evidence that they carry a raised risk for invasive cancer,36 and sometimes they are thought of as being pre-invasive disease or an early cancer. In 2009, 5,600 women were diagnosed with an in situ breast carcinoma in the UK; and there were 36 men in the UK diagnosed with in situ breast carcinoma.1-4

There are two main types of in situ carcinoma, ductal and lobular. Of the 5,430 women diagnosed in Great Britain in 2009, 4,563 (84%) had ductal carcinoma in situ (DCIS) disease and 516 (10%) had lobular carcinoma in situ disease. The remaining 351 (6%) women in Great Britain were diagnosed with other or unspecified in situ carcinoma of the breast.1-3

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