Patient stories, provider advice mark invasive lobular breast cancer awareness event – Fred Hutchinson Cancer Center

Epidemiological Report on Invasive Lobular Carcinoma and Alignment with Sustainable Development Goals

Introduction: Advancing SDG 3 Through Targeted Cancer Research

This report details key epidemiological findings regarding Invasive Lobular Carcinoma (ILC), a specific form of breast cancer. The research presented aligns directly with the United Nations’ Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all at all ages. By investigating the risk factors and rising incidence of ILC, this work contributes to Target 3.4, which seeks to reduce premature mortality from non-communicable diseases, including cancer, through prevention and treatment.

Historical Trends and Initial Findings

Collaborative research initiated by Dr. Roger Moe and conducted by Dr. Christopher Li of Fred Hutch documented a significant and disproportionate increase in ILC cases nationally. This investigation was foundational to understanding the scope of the public health challenge.

• A 65% increase in ILC incidence was observed over a defined period.
• In contrast, the incidence of all breast cancers combined rose by only 4% during the same period.

These statistics underscored the need for focused research into the specific drivers of ILC, a critical step in developing preventative strategies that support global health objectives under SDG 3.

Primary Risk Factor: Hormone Replacement Therapy (HRT)

Subsequent research identified a primary contributor to the rising ILC rates, directly impacting women’s health and well-being, a cornerstone of both SDG 3 and SDG 5 (Gender Equality).

1. Association with HRT: An initial association was found between the use of hormone replacement therapy and an elevated risk of lobular breast cancer.
2. Disproportionate Risk: The risk was markedly higher for ILC compared to ductal cancers. Women using HRT demonstrated a 2.6-fold increased risk of developing ILC.
3. Impact of Combined HRT: The Seattle-area Hormones And Reproductive Epidemiology (SHARE) study provided further detail, finding that long-term use of combined estrogen-plus-progestin HRT could increase ILC risk by up to four times.

This evidence is vital for informing healthcare policy and patient education, empowering women with the knowledge to make informed health decisions and advancing the goals of SDG 3 and SDG 5.

Secondary Risk Factors and Hormonal Sensitivity

The research confirms ILC as an “exquisitely hormonally sensitive” cancer, with additional factors influencing its development. Understanding these factors is crucial for comprehensive public health messaging and risk reduction.

• Alcohol Consumption: Identified as the most consistent dietary risk factor, alcohol consumption elevates internal estrogen levels. Studies, including the Women’s Health Initiative, demonstrated a significant link between alcohol intake (approximately two drinks per day) and ILC risk, while showing no similar relationship for ductal cancer.
• Progesterone-Only Contraceptives: The use of certain contraceptives, such as DMPA (Depo-Provera), was also found to increase breast cancer risk, reinforcing the link between external hormonal agents and ILC.

Conclusion: A Collaborative Effort Towards Global Health Goals

The research led by Dr. Li highlights two primary risk factors for ILC: combined HRT and alcohol consumption. This work, representing a partnership between multiple researchers and institutions (SDG 17: Partnerships for the Goals), provides critical data for public health. By identifying modifiable risk factors and issuing cautions, such as limiting combined HRT use to under three years, this research directly supports the preventative health targets of SDG 3. Continued investigation and public dissemination of these findings are essential to reducing the burden of non-communicable diseases and promoting gender equality in health outcomes.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

   • SDG 3: Good Health and Well-being
     
     The entire article is centered on health, specifically focusing on a non-communicable disease (NCD), Invasive Lobular Carcinoma (ILC), which is a type of breast cancer. It delves into epidemiological research, risk factors, and public health implications, all of which are core components of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.

2. What specific targets under those SDGs can be identified based on the article’s content?

   • Target 3.4: Reduce by one-third premature mortality from non-communicable diseases through prevention and treatment.
     
     The article directly supports the “prevention” aspect of this target. By identifying and quantifying major risk factors for ILC, such as the use of combined hormone replacement therapy (HRT) and alcohol consumption, the research discussed provides the foundational knowledge needed to create prevention strategies and public health advisories. For example, the article notes that combined HRT can lead to a “2.6-fold higher risk” and that alcohol is the “most consistent dietary risk factor associated with breast cancer risk.” This information empowers individuals and healthcare providers to make informed decisions to reduce the risk of developing this NCD.
   • Target 3.d: Strengthen the capacity for early warning, risk reduction and management of national and global health risks.
     
     The research led by Dr. Christopher Li serves as a mechanism for risk reduction and management of a national health risk. The article states that his work “documented that the increase in ILC was being seen nationally and that there had been a 65% increase of ILC over a short time period.” This epidemiological surveillance is a critical part of identifying and managing health trends, providing an evidence base for public health policy and clinical guidance.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

   • Incidence Rate of a Specific NCD: The article explicitly mentions a key indicator of the growing health issue: “a 65% increase of ILC over a short time period of time versus a 4% increase for all breast cancers.” Tracking the incidence rate of ILC is a direct way to measure the burden of this disease and the effectiveness of prevention strategies over time.
   • Prevalence of Key Risk Factors: The article implies the importance of tracking the prevalence of behaviors linked to ILC.
     • Hormone Replacement Therapy (HRT) Use: It states, “About 30% to 40% of women in the U.S. were using HRT at the time.” Monitoring the frequency and duration of HRT use in the population is a measurable indicator for assessing risk exposure.
     • Alcohol Consumption Levels: The article identifies a specific level of consumption as a high-risk factor: “particularly for women consuming about two drinks per day.” Tracking the percentage of the population consuming alcohol at this level serves as an indicator for targeted public health campaigns.
   • Quantified Risk Ratios: The research provides specific metrics that can be used as indicators of the severity of risk. For instance, “women who used HRT had a 2.6-fold higher risk of developing ILC,” and longer use could mean a risk “four times higher.” These ratios are crucial indicators for communicating risk to the public and medical community.

Summary of Findings

Source: fredhutch.org