Risk factors for breast cancer, with special reference to developing countries

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Abstract
For the past twenty years breast cancer has been the most common female malignancy in the world, and by the 1990s more than half the cases will occur in developing countries. The overall incidence rates for breast cancer have risen globally and some countries have experienced very sharp increases in the last two decades. Mortality rates for breast cancer have also shown increases over the last 40 years in virtually all countries. This review summarizes the main risk factors for breast cancer under ten headings. For eight of them the findings are presented in a tabular format. The remaining two are discussed in more detail in the text as they both have special relevance in predicting increasing rates for the disease in developing countries: demographic risk factors and those factors related to reproductive experience. There is little that can be done for primary prevention of breast cancer. Secondary prevention in developed countries has been shown to be effective, particularly through trials using mammography alone or in combination with clinical examination. However, the costs and organizational implications of establishing such services make them unaffordable for developing countries. Other alternatives to halt breast cancer mortality in the third world have to be fully examined - in particular through physical examination by non-medical personnel, and by breast self-examination.

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