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Breast cancer: prevention and control

Introduction Breast cancer is the top cancer in women both in the developed and the developing world. The incidence of breast cancer is increasing in the developing world due to increase life expectancy, increase urbanization and adoption of western lifestyles. Although some risk reduction might be achieved with prevention, these strategies cannot eliminate the majority of breast cancers that develop in low- and middle-income countries where breast cancer is diagnosed in very late stages. Therefore, early detection in order to improve breast cancer outcome and survival remains the cornerstone of breast cancer control. The recommended early detection strategies for low- and middle-income countries are awareness of early signs and symptoms and screening by clinical breast examination in demonstration areas. Mammography screening is very costly and is recommended for countries with good health infrastructure that can afford a long-term programme. Many low- and middle-income countries that face the double burden of cervical and breast cancer need to implement combined cost-effective and affordable interventions to tackle these highly preventable diseases. WHO promotes breast cancer control within the context of national cancer control programmes and integrated to noncommunicable disease prevention and control. WHO, with the support of Komen Foundation, is at present conducting a 5-year breast cancer cost-effectiveness study in 10 low- and middle-income countries. The project includes a programme costing tool to assess affordability. It is expected that the results of this project will contribute to provide evidence for shaping adequate breast cancer policies in less developed countries. Prevalence On January 1, 2008, in the United States there were approximately 2,632,005 women alive who had a history of cancer of the breast. This includes any person alive on January 1, 2008 who had been diagnosed with cancer of the breast at any point prior to January 1, 2008 and includes persons with active disease and those who are cured of their disease. Prevalence can also be expressed as a percentage and it can also be calculated for a specific amount of time prior to January 1, 2008 such as diagnosed within 5 years of January 1, 2008. (See Fast Stats for more detailed statistics, and Overview of Prevalence Statistics for methodology) Preventing Cholera by Avoiding Contaminated Food and Water Travelers who follow the usual tourist itineraries and observe food safety recommendations while in countries reporting cholera have virtually no risk. Risk increases for those who drink untreated water or eat poorly cooked or raw seafood in disease-endemic (prevalent) areas. For the prevention of cholera, all travelers who go to areas where cholera has occurred should observe the following recommendations:
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Drink only water that you have boiled, or that you have treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water, and carbonated, bottled beverages with no ice. Make sure that all vegetables are cooked, and avoid salads. Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself. Avoid undercooked or raw fish or shellfish, including ceviche (seafood marinated in lime or lemon juice). Avoid foods and beverages from street vendors. Do not bring perishable seafood back to the United States.

References Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds). SEER Cancer Statistics Review, 19752008, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data submission, posted to the SEER web site, 2011.