Descriptive Epidemiology The Burden of Breast Cancer Breast

Descriptive Epidemiology – The Burden of Breast Cancer
Breast cancer is the most common malignancy affecting women worldwide. Indeed, incidence and mortality is elevated in all high- and low-and-middle-income countries, with 13.8 million new cases in 2008, corresponding to 23% of all cancers. The incidence varies greatly, being highest among White women in the United States, Australia and New Zealand, and Western and Northern Europe (incidence over 80/100,000); and lowest among Asian women living in Asia and African women living in sub-Saharan Africa (incidence around or below 30/100,000). The wide range of female breast cancer mortality rates is less marked than variations in incidence, due to better survival in high-income countries compared to low-and-middle-income countries [1].
Time trends of the incidence of female breast cancer also vary markedly worldwide. In general these trends have been increasing over the last 5 decades, including in Asia and Europe. In the United States, following a THZ1 of steady increase, the trend has been declining over the last few years, probably due to the interruption of large-scale prescription of hormone replacement therapy in the last decade [2, 3]. Mortality trends generally follow trends of invasive breast cancer incidence.
Male breast cancer is a rare disease with incidence rates varying from 5 to 15 per 1,000,000. Rates are higher in North America and Europe, and extremely low in Asian populations. Indeed, female breast cancer incidence is 100% higher than male breast cancer incidence, which represents less than 1% of the cancers affecting men worldwide [4]. Studies on the time trends of male breast cancer indicate that its incidence is increasing, mimicking that of female breast cancer, although on a much smaller scale [5, 6].

General Epidemiology and Lifestyle- Related Risk Factors for Breast Cancer

Breast Cancer and Occupation – Final Considerations

Conflict of Interest

Acknowledgements

Introduction
Diabetes mellitus (DM) is now a major global health threat [1]. Worldwide numbers of affected people are expected to increase from an estimated 235 million in 2010 to 435 million in the year 2030 [2]. Statistics such as these have prompted the World Economic Forum to rank chronic diseases, of which diabetes is unarguably dominant, among three major risk areas in order to discuss the diseases in its Global Risks Network Report [3]. The growing burden of the disease is more acute in developing countries because of the higher prevalence of diabetes in the working age group of 40 to 60 years, compared to developed countries, where the majority with the disease is above 60 years of age [2].

Diabetes Mellitus Affecting Work
The multidimensional nature of diabetes is well known. A holistic approach for its management is necessary [4] to reduce both microvascular and macrovascular complications [5,6]. Time and effort is required for adherence to a treatment regime that requires scheduled screening for retinopathy, foot, renal, and cardiovascular risk factors [7]. Most of these factors take time to develop, and its impact on work is probably not immediate, allowing time for affected workers, their supervisors, and physicians to adjust to changing circumstances.
A major immediate concern in the management of workers with diabetes is the impact of hypoglycemia, quite often an iatrogenic effect of diabetes management. This condition is not rare (Table 1). In one study, 101 of 518 type1 diabetics above 16 years of age with diabetes durations exceeding two years had hypoglycemic unawareness in the preceding year [9]. In another study, twelve out of 122 insulin type2 diabetics using two or more insulin injections a day were noted to have hypoglycemic unawareness in the preceding year [10].

Hypoglycemia – A Safety Risk
The neurogenic and neuroglycopenic effects elicited through sympathetic arousal, such as perspiration, palpitations, hunger, giddiness, and tremors are often familiar to diabetic patients. This response is mediated by catecholamines. The level of distress caused by such effects is not often appreciated by others, even by doctors. Secretion of cortisol and growth hormones form the latter stages of the hypoglycemic response [11].