1. Jo Anne Zujewski, MD Clinical Investigations Branch Cancer Therapy Evaluation Program Division of Cancer Diagnosis and Treatment May 2011 The Global Burden of Breast Cancer

3. Breast Cancer: Most common cancer in developed and developing world 1.38 million cases in 2008 –Most frequent cancer in women (23% of all cancers) Incidence –19.3/100,000 women in East Africa –89.7/100,000 women in Western Europe GLOBOCON

4. Globocon Breast Cancer Incidence 2008

5. Breast Cancer Mortality 6-19 per 100,000 due to more favorable survival in (high-incidence) developed regions Most frequent cause of cancer death in women in both developing (269,000 deaths) and developed regions (189,000 deaths).

6. Globocon Breast Cancer Mortality 2008

8. Thun, M. J. et al. Carcinogenesis 2010 31:100-110; doi:10.1093/carcin/bgp263 Number and distribution of cancer cases by level of economic development and year (assuming no change in the annual incidence rate)

9. Breast Cancer Rates are Rising… ‘Westernization' of lifestyles Urbanization Dietary habits and physical inactivity Changes in reproductive factors such as lower rates of childbearing Exposure to exogenous estrogen

10. Trends in Mortality

11. Berry D.A., et al. N Engl J Med. 353:1784-92, 2005 Decrease in breast cancer mortality

12. Cancers in Women: Uzbekistan Uzbekistan Incidence 19.2/100,000 (2174 cases) Mortality 10.2/100,000 (1111 deaths)

13. How effective is therapy for breast cancer? stage5 year survival 093 % I88 % IIA81 % IIB74 % IIIA67 % IIIB41 % IIIC49 % IV15 % years5 year survival 1974-197675 % 1983-198578 % 1992-199786 % 1995-200389 % National Cancer Data Base breast cancer diagnosis 2001 and 2002. SEER, 1973-2003, DCP, NCI, 2009

14. No surgery mastectomy chemoTx + antiER chemoTx + antiER + targeted Incremental Benefit

15. Breast cancer rates increasing- approaches require: Guidelines that are evidence-based, economically feasible, and culturally appropriate Early detection - metastatic disease is not treated successfully in ANY country Improved cancer registries and data collection Clinical trials in developing countries

16. In the name of life….