Breast cancer - UK incidence statistics

Breast cancer is the most common cancer in the UK despite the fact that it is rare in men. In 2006 there were 45,822 new cases of breast cancer diagnosed in the UK: 45,508 (over 99%) in women and 314 (less than 1%) in men.

Table 1.11-4 shows the numbers and rates of new cases of breast cancer in the UK and its constituent countries. The lowest rates are recorded in Northern Ireland and this has been a consistent pattern since Northern Ireland cancer registration rates became available in 1993.19

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Breast cancer is by far the commonest cancer in women in the UK accounting for 31% of all cases in women. The next most common cancer in women is lung cancer, with 16,647 cases (11% of total) in 2006. 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 is 1 in 1,014 for men and 1 in 9 for women in the UK. These were calculated on February 2009 using incidence and mortality data for 2001-2005. 5

Breast cancer risk is strongly related to age,with 81% of cases occurring in women aged 50 years and over. Nearly half (48%) of cases of breast cancer are diagnosed in the 50-69 age group ( Figure 1.11-4): these women and those aged 70 are targeted in the national screening programme. From 2009 onwards, the NHS Breast Screening Programme will extend the age range of women eligible for breast screening to ages 47 to 73 over time. The extension is due to be complete by 2012. For more information on breast cancer screening go to the screening section.

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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 35. Among women aged 35-39 around 1,500 cases of breast cancer are diagnosed each year. Breast cancer incidence rates generally increase with age, with the greatest rate of increase prior to the menopause, supporting a link with hormonal status.

Worldwide, more than a million women are diagnosed with breast cancer every year, accounting for a tenth of all new cancers and 23% of all female cancer cases. 6 Breast cancer incidence rates vary considerably, with the highest rates in the North America and the lowest rates in Africa and Asia (Figure 1.2). 6

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Around 429,900 new cases of breast cancer occur each year in Europe and an estimated 182,460 in the USA 7, 37. The lowest European rates are in eastern and southern Europe and the highest are in northern and western Europe.( Figure 1.3).

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The risk for women who migrate from low to high risk countries typically increases suggesting a strong effect for lifestyle or environmental factors. For example, Japanese migrants to the USA experience rapidly increasing breast cancer rates. 8, 9

An analysis of cancer incidence and mortality from 1991 to 2000 within the UK and Ireland reported relatively little geographical variation for either breast cancer rate.10 At the regional and country level, the European age-standardised rates (EASR)11 for breast cancer incidence ranged from 97 per 100,000 in Ireland to 116 per 100,000 in the South East of England. In England rates were slightly higher than average in the south and slightly lower than average in the north but very few areas  differed by more than 10% from the average. 

In Ireland rates were generally more than 10% below the average. A more recent examination of incidence rates within the UK for 2005 also reported only modest variation in breast cancer incidence for the majority of cancer networks.12

Breast cancer is one of the few cancers where incidence rates are higher for more affluent women and there is a clear trend of decreasing rates from least to most deprived groups.13 An analysis of incidence rates in Scotland for patients registered from 2001-2005 showed a 6% difference between the rates in the least deprived (EASR 118.7 per 100,000) and the most deprived (EASR 111.0 per 100,000) areas. 14

In England, a study of incidence for patients diagnosed between 1998 and 2003 by socio-economic group and region, also reported modest differences between socio-economic groups with the highest rates for the most affluent groups.15 The most recent study in England comparing deprivation for cancer patients in two time periods, 1995-99 and 2000-04, reported that rates in the most deprived groups in 2000-04 were around 20% lower than in the most affluent.16 If all groups had the rates of the most affluent then there would be an additional 2,500 new breast cancer cases each year in England.16 These results are not unexpected as many of the risk factors for breast cancer, for example, late first pregnancy and lower parity are generally more prevalent in the more affluent groups in society.

The incidence of breast cancer has been increasing for many years in economically developed countries 17,18. From the late 1970s until the introduction of breast screening, the increase in Britain was around 2% per annum 19. The introduction of the national screening programme in 1988 led to a transient additional increase in incidence as a prevalent pool of undiagnosed cancers were detected (Figure 1.41-3).

Over the thirty year period 1977-2006 in Britain, the European age-standardised incidence rate (EASR) increased by 63% from 75 per 100,000 in 1977 to 122 per 100,000 in 2006. Over the same time period the annual number of new cases of breast cancer almost doubled from 23,463 to 44,528 in Britain .(Figure 1.41-3).

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Figure 1.5 shows the breast cancer incidence trend for the UK. In the last ten years in the UK, the EASR has increased by 6% from 114 per 100,000 in 1997 to 121 per 100,000 in 2006, while the numbers of cases rose from 39,819 to 45,508, and increase of 14%.

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During the 1990s the increase in the use of hormone replacement therapy (HRT) is thought to have also contributed to the increase in incidence 20. Analysis of incidence trends by deprivation group showed that incidence rose more rapidly in affluent women than among deprived women between 1986 and 1999, and the higher use of HRT in affluent women may have contributed to this21.

The trends by age-group show clearly that the steep increase in incidence following 1988 was largely confined to women aged 50-64 who were invited to join the breast screening programme (Figure 1.61-3). The most recent rates show a downturn for this age-group. 

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A steep decrease in incidence since 2002 for women aged 50 or older has been noted in the USA and linked to the sudden drop in HRT use following publication of the Women's Health Initiative (WHI) Trial results 18, 22-24.  (The WHI trial was a randomised controlled trial of estrogen-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 25. 

Similar trends have been seen in other countries 26. In Scotland a recent 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 27. In the UK as a whole, the use of hormonal preparations rose steeply from 1992 to reach a maximum in 2000-01 when approximately 25% of women aged 45-69 were using them; the percentage has fallen to half that in 2006 28. It has been estimated that due to the fall in the use of HRT, there were 1,400 fewer cases of breast cancer at ages 50-59 in the UK in 2005 than would have occurred if no such fall in use had happened 28.The recent steep rise in rates for women aged 65-69 is almost certainly caused by the introduction of national breast cancer screening for this age-group (Figure 1.7 38).

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Projections for Britain from 2005 until 2024 show that the EASR is expected to increase from 119 per 100,000 in 2000-04 to 124 per 100,000 in 2020-24. Over the same time period, the average number of cases per year will rise from 41,900 to 55,700 new cases, that is, more than double the number of cases registered in the late 1970s 29 (the projected number of cases in the UK in 2024 is 57,000).

The historically lower rates in central and Eastern Europe and the Far East have begun to rise rapidly30-32. For example, in Japan, where breast cancer incidence rates have more than doubled over the last 40 years, breast cancer is now the most common form of cancer in women, and rates are likely to continue rising 33.

China, with a fifth of the world’s female population, has already seen dramatic rises in incidence in some cities such as Shanghai and if these trends spread to the rest of the country, a substantial increase in the number of cases is predicted 34. These increases have been linked to changes in reproductive behaviour (in China the average birth rate fell from 5.9 births per woman in 1970 to 2.9 in 1979 and 1.7 in 2004 35) and lifestyle risk factors such as weight gain, alcohol consumption and the use of hormone replacement therapy.

As the incidence of breast cancer is high, and five-year survival rates are over 80%, many women are alive who have been diagnosed with breast cancer. The most recent estimate based on diagnoses up to the end of 2004 applied to the population in 2008 suggests that around 550,000 women are alive in UK who have had a diagnosis of breast cancer 36. This equates to more than 2% of the total female population and nearly 12% of the population aged 65 years and older.

Nearly all invasive breast cancers are adenocarcinomas (derived from glandular tissue), either ductal (85%) or lobular (15%.)

Ductal carcinoma in situ (DCIS), a non-invasive cancer, is now detected much more frequently because of the widespread use of mammography.

Acknowledgements

Cancer Research UK would like to thank Dr David Brewster, Dr Gill Lawrence, Professor Julietta Patnick, Dr Paul Pharoah, Dr Gillian Reeves, Dr Elena Takeuchi and Professor Chris Twelves for their kind help and expert advice on the content of the breast cancer pages. We would also like to thank Dr Catherine Lagord for supplying the survival by stage data from the West Midlands. However the contents of the breast cancer pages are entirely the responsibility of Cancer Research UK.

We would also like to acknowledge the essential work of the cancer registries in the United Kingdom Association of Cancer Registries (UKACR). Without these cancer registries there would be no incidence or survival data.