The Theory of the Sick Lobe

Abstract

Breast carcinoma is among the most frequent malignant diseases in the world and is the leading cause of premature death among younger women in developed countries. Currently, every tenth to every seventh woman in these countries will have the disease in their lifetime (Boyle and Ferlay 2005). Since 1940, the incidence of breast carcinoma has gradually increased at a rate of approximately 1% per year in Western countries (Harris et al. 1992). On the other hand, mortality from breast cancer has declined in countries with organized population-based mammography screening (Smith et al. 2004; The Swedish Organized Service Screening Evaluation Group 2006), and new efficient therapeutic regimes have led to prolonged survival of patients with improved quality of life (Hortobagyi 2005). These interventions have considerably increased the number of breast cancer survivors, and a further increase of 31% is expected in the decennium from 2005 to 2015 (De Angelis et al. 2009). Although a decreased incidence has been observed in some industrial countries over the last few years, other countries, among them China and India with their very large populations, experience a continuous and constant increase in incidence (Kawamura and Sobue 2005). An increase of 30% in the number of detected cases between 2010 and 2030 was estimated in the US based on current epidemiological trends, with a 57% increase for women older than 65 years (Smith et al. 2009). This increase may result in every fourth or every third woman in these countries carrying a risk of breast carcinoma in their lifetime (Fig. 1.1). Screening, diagnosis, and treatment will place an ever growing burden on the health care system, in addition to the psycho-social consequences for the women of coming generations. Obviously, a paradigm shift in understanding the natural history of breast carcinoma is needed to develop new and more efficient preventive, diagnostic, and therapeutic alternatives and break the negative trend.