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Abstract
In the ranking of cancer incidence in the year, female breast cancer was the highest cancer after thyroid cancer in 2004-2015, and became the most common cancer in 2016, exceeding the cases of thyroid cancer. The incidence rates of breast cancer have increased steadily over the past two decades and are expected to continue to increase in the next decades, although the incidence rates of all other cancers has declined in Korea. Most of the established risk factors of breast cancer are primarily related to female sex hormones. Other known risk factors are alcohol drinking, a family history of breast cancer, genetic predisposition, and benign breast conditions. Some risk factors, such as physical activity, breastfeeding, and number of children, are modifiable factors that can be targeted for risk reduction. This article summarizes the descriptive epidemiological characteristics of breast cancer in Korea that have been reported and identifies the specific characteristics and secular trends in incidence, mortality, and survival rates of breast cancer up to the present day. It is uncertain whether the risk factors established in western populations will also be valid for the Korean population. To explore this question, we summarize the results from international collaborative studies and metaanalyses of risk factors of breast cancer published to date. The results for Koreans are summarized and described based on results from population-based or nested case-control studies, hospital case-community control studies, cohort studies, and metaanalyses conducted in Korea. This study will be helpful for risk assessment, interventions, and prevention of breast cancer.
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Figure 1.
Secular trend in age-standardized incidence and mortality rates (per 100,000) and mortality-incidence ratio (MI ratio) of female breast cancer between 1996 and 2017, Korea. Data from Korean Statistical Information Service [1] and National Cancer Center [2].
Figure 2.
Secular trends in age-standardized incidence rates (per 100,000) of female breast cancer between 1999 and 2016 in Korea. Data from Korean Statistical Information Service [1] and National Cancer Center [2]. a)P<0.05.
Figure 3.
Secular trend in age-standardized mortality rates (per 100,000) of female major cancers between 1996 and 2017, Korea. Data from Korean Statistical Information Service [1] and National Cancer Center [2]. a)P<0.05.
Figure 4.
Age-specific mortality-incidence ratio (MI ratio) of female breast cancer between 1999 and 2016, Korea. Data from Korean Statistical Information Service [1] and National Cancer Center [2].
Figure 5.
Secular trends in age-specific incidence rates of female breast cancer in Korea. Data from Korean Statistical Information Service [1] and National Cancer Center [2].
Figure 6.
Secular trends in age-specific mortality rates of female breast cancer in Korea. Data from Korean Statistical Information Service [1].
Table 1.
Five-year relative survival rates of breast cancer in Korea
Table 2.
Risk factors of breast cancer in Korea
| Risk factors associated with increased breast cancer risk | Risk factors associated with decreased breast cancer risk |
|---|---|
| Individual susceptibility factors | |
| Increased age Family history of breast cancer in 1st | Low-penetrance genetic factors |
| and 2nd degree relatives | |
| High-penetrance genetic factors (BRCA1, BRCA2 mutations, etc.) | |
| Low-penetrance genetic factorsa) | |
| Female reproductive factors | |
| Early age at menarche | Oophorectomy |
| Late age at menopause Late age at the first fullterm-pregnancy (or the first parity) | Hysterectomy (risk reduction for only hysterectomy without oophorectomy) |
| Nulliparous women (no child) | The more children, the less risk |
| No breastfeeding | The longer the breastfeeding period, the lower the risk |
| Benign breast conditions | |
| Benign breast disease | |
| Dense breast at mammography | |
| Risk factors presented by internationally recognized research institutes | |
| <Category A> Sufficient evidence as a human carcinogen (Group 1) by the IARC, WHO | |
| <Category B> Strong evidence for a ‘convincing causal relation’ by WCRF/AICR | |
| <Category C> Strong evidence for a ‘probable causal relation’ by WCRF/AICR | |
| Alcohol drinking <A><B><C>b) | Breast feeding <C> |
| Longer duration of breast feeding <C> | |
| E-P combined HRT <A> | |
| E-P combined oral contraceptives <A> | |
| Height <B> | |
| Obesity in adult (measured by BMI, waist circumference, or waist-hip ratio) (postmenopausal women only) <B> | Intense physical activity (both premenopausal and postmenopausal women) <C> |
| Weight gain in adults (postmenopausal women only) <B> | All kinds of physical activity (postmenopausal women only) <B> |
IARC, International Agency for Cancer Research; WHO, World Health Organization; WCRF, World Cancer Research Fund; AICR, American Institute for Cancer Research; E-P, estrogen-progesterone; HRT, hormone replacement thera py; BMI, body mass index.
Table 3.
Primary prevention of breast cancer: risk factor modification
| Risk factor modification for breast cancer primary prevention |
|---|
| Obesity and overweight control |
| Optimal weight maintenance |
| Restriction of alcohol drinking |
| No cigarette smoking |
| Active physical activitya) |
| Breastfeeding during the appropriate periodb) |
| Prescription of E-P combined oral contraceptives or HRT |
| based on individual risk assessmentc) |
| E-P, estrogen-progesterone; HRT, hormone replacement therapy. a)Active physical activity that causes rapid breathing and increased heart rate, such as running, walking and climbing, active and fast cycling, aerobic, quick swimming, Competitive sports (e,g., soccer, volleyball, hockey, basketball), heavy shoveling/dig-ging, trenching and hauling / moving [>20kg]). b)Breastfeeding is associated with a reduced risk of breast and ovarian cancer, and contributes to postpartum weight loss and reduced blood pressure. The WHO recommends women to breastfeed exclusively (notcombined milk-feeding) for at least the first 6 months, and to continue breastfeeding for at least 2 years thereafter. c)The risk of breast cancer and cardiovascular disease is increased when women over 60 years of age use E-P complex HRT. However, women under the age of 60 can avoid bone fractures and osteoporosis when using E-P complex HRT. When women use the E-P compound contraceptive, the risk of breast cancer is slightly increased. However, the use of E-P conjugate contraceptives prevents young women from experiencing unwanted pregnancies, reduces the risk of uterine cancer, ovarian cancer and colon cancer, and is effective in the treatment of postmenopausal syndrome and endometriosis. Therefore, doctors should make individual risk assessments according to patients’ personal risk status prior to prescriptions of E-P combined oral contraceptives and HRT, and then should decide on their prescription according to their risk priorities. |
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