A Message from the California Breast Cancer Research Program Director

Marion H. E. Kavanaugh-Lynch, M.D., M.P.H.

We are pleased to provide this summary of the status of breast cancer in California. This report provides the most current picture available of breast cancer's effect on the lives of the women of our state. The picture that emerges is mixed.

The good news is that the breast cancer death rate dropped from 32.4 per thousand California women in 1988 to 24.5 in 1999. There is debate about the reasons for this improvement. Some argue that it is because we are detecting breast cancer earlier. While it is true that more and more California women are getting regular breast cancer screening and we are detecting more and more early stage breast cancers, we are not seeing a significant drop in late stage cancers (the cancers that have spread to other parts of the body). Thus, it is more likely that the drop in the breast cancer death rate is due to improvements in treatment, either through improved therapies or more widespread use of the therapies we have.

The bad news is that the rate at which California women get breast cancer has climbed 25% in the past 20 years. There is no indication from the data available from the California Cancer Registry what is causing this increase, or how to prevent it. There are few ways an individual women can cut down her chances of getting breast cancer, and none proven to completely prevent it.

We would expect the widespread use of screening mammography to reduce the rate at which women are diagnosed at a late stage (after their tumors have spread, when treatment is less effective). However, there has been almost no change in late stage diagnoses. Meanwhile, the widespread use of screening mammography has resulted in a 500% increase in the diagnosis of in situ breast cancer, a localized tumor that does not spread to other parts of the body. Because these tumors are usually seen only with mammography, they were quite rarely diagnosed in the past, and we do not really know how best to treat them.

We must find out why breast cancer is still on the rise and find ways to prevent it. We need better detection methods that can reduce the rate of late stage diagnoses and distinguish fastgrowing dangerous tumors from innocent ones. We must develop treatments that will guarantee that women who develop breast cancer will survive. Not just five years, or ten years, but for decades.

These are the goals for the California Breast Cancer Research Program. We will continue to push for innovative, creative research in these areas until we have changed the face of breast cancer in California.

Marion H. E. Kavanaugh-Lynch, M.D., M.P.H.

Marion H. E. Kavanaugh-Lynch, M.D., M.P.H.