Age-adjusted Breast Cancer Incidence Research Articles

Abstract PO5-08-12: Ethnic Admixture Affects Breast Cancer Incidence in Native Hawaiians: The Multiethnic Cohort

Abstract Background Native Hawaiians (NH) have the highest breast cancer incidence and the poorest survival of any ethnic group in Hawaii [1]. Since it has been shown that different ethnic groups have disparate risk of breast cancer in Hawaii and NHs are commonly of mixed ancestry, it is possible that the specific ethnic admixture may present an altered risk profile. For example, NH with Asian admixture was associated with higher risk for type 2 diabetes independent of known risk factors [2] compared to those without. The objective of this study was to calculate crude and age-adjusted breast cancer incidences by ethnic admixture group among participants of the Multiethnic Cohort (MEC). Methods: Based on self-reports, 106,525 eligible women were categorized by broad ethnic categories: Native Hawaiian, White, Black, Latino, and Japanese. In total there were 9257 breast cancer cases in the MEC cohort (1996-2019) at time of analysis. The Native Hawaiian population was further categorized into the following subgroups: Native Hawaiian only, Native Hawaiian & White, Native Hawaiian & Chinese, Native Hawaiian & White & Chinese. Crude and age-adjusted incidence rates (per 1000 person-years) were calculated for the various groups. The direct method of age adjustment using the US 2000 Standard population was used. Results: The ethnicity with the highest crude incidence were White=88.46, followed by Black=85.20, Latino=84.27, Japanese=84.90, and Native Hawaiian=81.28. However, after age-adjustment the highest were Japanese=159.1, White=153.8, Latino=148.3, Black=147.4, and Native Hawaiian=139.1. Crude incidence rates for Native Hawaiian ethnic admixture was found to be highest for Native Hawaiian & White=83.5, Native Hawaiian only=82.5, Native Hawaiian & Chinese=80.8, and Native Hawaiian & White & Chinese=80.4. After age adjustment, the highest was Native Hawaiian & Chinese=173.9, followed by Native Hawaiian & White=154.3, Native Hawaiian only=148.7, and finally Native Hawaiian & White & Chinese=120.8. Conclusion: These findings indicate that ethnic admixture in Native Hawaiians may be at elevated age-adjusted breast cancer incidence when compared to Native Hawaiian alone. When a woman was Native Hawaiian and Chinese the incidence was notably higher than any other group at 173.9 when compared to all Native Hawaiian=139.1. Furthermore, the group that had the lowest age-adjusted incidence was the mixed group of Native Hawaiian & White & Chinese=120.8 which seems to account for why the overall Native Hawaiian group=139.1 had one of the lowest incidence rates of the 5 major ethnic groups. 1. Loo, L.W., M. Williams, and B.Y. Hernandez, The high and heterogeneous burden of breast cancer in Hawaii: A unique multiethnic US Population. Cancer epidemiology, 2019. 58: p. 71-76. 2. Maskarinec, G., et al., Ethnic admixture affects diabetes risk in native Hawaiians: the Multiethnic Cohort. Eur J Clin Nutr, 2016. 70(9): p. 1022-7. Citation Format: Dustin Valdez, Arianna Bunnell, David Bogumil, Gertraud Maskarinec, John Shepherd. Ethnic Admixture Affects Breast Cancer Incidence in Native Hawaiians: The Multiethnic Cohort [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-08-12.

A population health assessment of screening mammography on breast cancer mortality in North Carolina.

To identify predictors of screening mammography use and the effect of screening mammography on breast cancer mortality in North Carolina. This cross-sectional study integrated publicly available data from government and private data repositories to model predictors of screening mammography and breast cancer mortality in North Carolina. In North Carolina during 2008-2010, on average, 68.1% of women aged 40-74years underwent a screening mammogram in the previous two years (range: 38.7%-82.1). The ordinary least squares (OLS) regression demonstrated counties experiencing persistent poverty have mammography screening rates that are 4.3% less, on average, than counties without persistent poverty (estimate (SE) = -4.283 (2.105), p = 0.045). As the percentage of women with a college education increases, the mammography screening rates increase by approximately 0.3% (estimate (SE) = 0.319 (0.078), P < .001) and as the health literacy score increases, the mammography screening rate decreases by 0.3% (estimate (SE) = -0.318 (0.104), p = 0.003). These variables explain 7.0% of the variability in mammographic screening rates. The OLS regression analysis demonstrated that age-adjusted breast cancer incidence (Estimate (SE) = 0.074 (0.024), p = 0.003) and health literacy score (estimate (SE) = -0.175 (0.083), p = 0.039) are significantly related to breast cancer mortality. Demographic, socioeconomic, and environmental variables explain only a small percentage of the variability in the rates of screening mammography and breast cancer mortality in North Carolina. Advances in the available treatments are likely the major contributor to improving breast cancer mortality.

Ambient air emissions of endocrine-disrupting metals and the incidence of hormone receptor- and HER2-dependent female breast cancer in USA.

Limited evidence exists on the relationship between exposure to endocrine-disrupting metals in ambient air and hormone receptor- and HER2-dependent breast cancer. This study investigates the association between ambient air emissions of endocrine-disrupting metals and the incidence of female breast cancer of different receptor status. County-level data from the US national datasets were analyzed for the association between emissions of various metals including arsenic, cadmium, chromium VI, lead, and mercury, and the annual age-adjusted incidence of hormone receptor-dependent breast cancer for 1990-2016 and HER2-dependent breast cancer for 2010-2016 using adjusted linear regression models. Lead emissions showed the strongest association among the metals examined with the incidence of different receptor status breast cancers, including ER-positive, ER-negative, PR-negative, HER2-negative, and Triple-negative breast cancers, with the adjusted β ranging from 917.26 for ER-negative to 3182.37 for HER2-negative breast cancer. Arsenic and mercury showed significant associations with the incidence of ER-positive, ER-negative, PR-positive, and PR-negative breast cancers. However, cadmium emissions were only significantly associated with ER-negative breast cancer. Moreover, chromium was not associated with any subtypes of breast cancer. Among all of the metals, only lead and mercury emissions showed significant associations with HER2-negative and Triple-negative breast cancer incidence. The results from this study suggest that increased exposure to endocrine-disrupting metals, especially lead, in ambient air could be associated with an increased incidence of female breast cancers with various receptor status in the US. Prospective studies are warranted to further explore this relationship.

Trends in breast cancer incidence rates by race/ethnicity: Patterns by stage, socioeconomic position, and geography in the United States, 1999‐2017

The incidence rate of breast cancer has been increasing over time across race/ethnicity in the United States. It is unclear whether these trends differ among stage, poverty, and geography subgroups. Using data from the North American Association of Central Cancer Registries, this study estimated trends in age-adjusted breast cancer incidence rates among women aged 50 to 84 years from 1999 to 2017 by race/ethnicity (non-Hispanic Black, non-Hispanic White, and Hispanic) and across subgroups (stage, county-level poverty, county urban/rural status, and geographic region [West, Midwest, South, and Northeast]). From 2004 to 2017, breast cancer incidence rates increased across race/ethnicity and subgroups, with the greatest average annual percent increases observed for non-Hispanic Black women, overall (0.9%) and those living in lower poverty areas (0.8%), rural areas (1.2%), and all regions except the West (0.8%-1.0%). Stronger increases among non-Hispanic Black women were observed for local-stage disease and for some subgroups of distant-stage disease. Non-Hispanic Black women had the smallest decrease in regional-stage disease across most subgroups. Similarly, Hispanic women had the strongest increases in some subgroups, including areas with higher poverty (0.6%-1.2%) and in the West (0.8%), for local- and distant-stage disease. These trends highlight concerns for an increasing burden of breast cancer among subpopulations, with some already experiencing disparate breast cancer mortality rates, and they highlight the need for targeted breast cancer prevention and efforts to reduce mortality disparities in areas with increasing incidence.

Abstract 2531: Function-related indicator and outcomes of screening mammography in older women from the BCSC-Medicare Cohort

Abstract Background: Although there is evidence pointing to the role of comorbidity and age in screening mammography outcomes among older women, the impact of functional decline on mortality in this population is unknown. Methods: We used data from 238,849 women in the Breast Cancer Surveillance Consortium-Medicare (BCSC) linked database from 1999-2015 who had at least one screening mammogram at ages 66-94 years. We estimated the 10-year cumulative incidence of breast cancer, breast cancer death, and non-breast cancer death by function-related indicator (FRI) which incorporated 16 claims-based items reflecting functional or health status in older people. In the analysis, FRI score was categorized as an ordinal variable (0, 1, and 2+) and a higher score indicated a higher burden of functional limitations. Fine and Gray proportional sub-distribution hazards models were applied with incident breast cancer and death treated as competing events. Risk estimates by FRI scores (0, 1, and 2+) were adjusted by age and NCI comorbidity index separately and stratified by these factors. Results: During a median follow-up of 101 months, 9,252 women were diagnosed with breast cancer. During follow-up, 406 women died of breast cancer and 41,640 died from non-breast cancer causes. The 10-year age-adjusted cumulative incidence of invasive breast cancer slightly decreased with increasing FRI score (FRI=0: 4.0%, 95% CI=3.8%-4.1%; FRI=1: 3.9%, 95% CI=3.7%-4.2%; FRI=2+: 3.5%, 95% CI=3.1%-3.9%). Risk of death from non-breast cancer causes increased with FRI score (FRI=0: 18.8%, 95% CI=18.5%-19.1%; FRI=1: 24.4%, 95% CI=23.9%-25.0%; FRI=2+: 39.8%, 95% CI=38.8%-40.9%). Risk of breast cancer death was low with minimal risk differences across FRI scores (FRI=0: 0.24%, 95%CI=0.20%-0.28%; FRI=1: 0.20%, 95%CI=0.14%-0.26%; FRI=2+: 0.30%, 95% CI=0.18%-0.42%). Risk estimates in NCI comorbidity index-adjusted models were largely similar to outcomes in age-adjusted models. Stratified analyses suggested similar patterns of risk estimates by FRI. Conclusion: Cumulative risk of death from non-breast cancer causes substantially increases with FRI score, suggesting that the potential of screening mammography to benefit older women is low among those with a high burden of functional limitation. Citation Format: Dongyu Zhang, Linn Abraham, Joshua Demb, Diana L. Miglioretti, Shailesh Advani, Brian L. Sprague, Louise M. Henderson, Tracy Onega, Karen Wernli, Louise C. Walter, Karla Kerlikowske, John T. Schousboe, Ellen S. O'Meara, Dejana Braithwaite. Function-related indicator and outcomes of screening mammography in older women from the BCSC-Medicare Cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2531.

Population Trends in Lobular Carcinoma of the Breast: The Ontario Experience.

Invasive lobular carcinoma (ILC) is less common that invasive ductal carcinoma (IDC), and more challenging to diagnose by examination and screening mammography. This study evaluated current trends in ILC incidence, and described the 5-, 10-, and 15-year survival probabilities for women diagnosed with ILC in Ontario, Canada. This retrospective cohort analysis included all women aged 18years and older diagnosed with breast cancer between 1991 and 2015. Health administrative data from the Institute of Clinical Evaluative Sciences and the Ontario Cancer Registry were used to identify breast cancer cases. Age-adjusted incidence was plotted by year. Crude proportions were plotted by year of diagnosis for stage and hormone receptor status. Kaplan-Meier curves were generated to determine the 5-, 10-, and 15-year survival probabilities for ILC and IDC. From 1991 to 2015, there were 194,065 cases of breast cancer in Ontario, 14.7% of which were ILC. The age-adjusted incidence of breast cancer increased 1.04-fold, while ILC rates increased 1.53-fold. All bilateral breast cancers were of lobular origin. The proportion of stage 1 ILC decreased, while the proportion of stage 2-4 ILC increased. The 5-, 10-, and 15-year overall survival probabilities for women diagnosed with ILC were 82.7%, 65.3%, and 50.2%, respectively. This study contains the largest population dataset of ILC evaluated to date. While total breast cancer incidence rates in Ontario are largely unchanged, ILC incidence rates are steadily increasing and there is a trend towards diagnosis of ILC at a later stage. These trends highlight the ongoing diagnostic and treatment challenge ILC presents for patients and clinicians.

Forty-year trends in menopausal hormone therapy use and breast cancer incidence among postmenopausal black and white women.

After reports from the Women's Health Initiative randomized trial evaluating estrogen plus progestin, there was a sudden, substantial, and sustained decrease in all categories of menopausal hormone therapy, and the first reduction in age-adjusted breast cancer incidence in more than 20years was seen in 2003-2004 among US women 50 years of age or older. Subsequent trends in breast cancer incidence have been described, but most reports have not focused on the postmenopausal age group or fully engaged the potential influence of reduced hormone therapy on breast cancer incidence trends by race/ethnicity. To address this gap, this commentary examines trends for annual age-adjusted breast cancer incidence over a 40-year period from 1975 to 2015 for white and black women on the basis of findings from the Surveillance, Epidemiology, and End Results 9 registries. Overall, the sharp decline in breast cancer incidence seen in 2003-2004 was followed in the subsequent decade by a continued low breast cancer incidence plateau in white women that has largely persisted. In contrast, a new discordance between breast cancer incidence trends in black and white women has emerged. In the 2005-2015 decade, a sustained increase in breast cancer incidence in black women has resulted in annual incidence rates comparable, for the first time, to those in white women. This commentary explores the hypothesis that the over-decade-long and discordant changes in breast cancer incidence rates in postmenopausal black and white women are, to a large extent, associated with changes in hormone therapy use in these 2 groups.

Trends in Parity and Breast Cancer Incidence in US Women Younger Than 40 Years From 1935 to 2015

During the past several decades, breast cancer incidence has been increasing for women younger than 40 years. The increase matches the decrease in parity, an established breast cancer risk factor, but secular trends in incidence have not been examined prior to the 1970s. To examine whether secular trends in parity explain the increase in breast cancer incidence among US women aged 25 to 39 years from 1935 to 2015. This population-based cohort study used population-based aggregate-level data from the Connecticut Tumor Registry (CTR) to examine breast cancer incidence and age-standardized rates among women aged 25 to 39 years from 1935 to 2015. National mean live births were calculated using birth data from the National Vital Statistics System (NVSS) from 1930 to 2015 (allowing for 5-year lag). Linear regression was used to compare a baseline model of year estimating age-adjusted breast cancer incidence rate with a model that adjusted for parity constructs. Breast cancer incidence rates among women aged 25 to 39 years from 1935 to 2015. Among women in Connecticut aged 25 to 39 years from 1935 to 2015, incidence of breast cancer for women aged 25 to 39 years increased 0.65% (95% CI, 0.53%-0.77%) per year, from 16.3 breast cancer diagnoses per 100 000 women in 1935 to 38.5 breast cancer diagnoses per 100 000 women in 2015. This increase began nearly 4 decades before the secular decrease in parity (mean [SD] parity peaked at 2.26 [0.87] live births per woman in 1966 and in 2010 had decreased to 1.41 [0.71] live births per woman). Age-specific parity trends explained only 0% to 4% of the variability in incidence over time. These findings suggest that breast cancer incidence for women aged 25 to 39 years has been significantly increasing since the 1930s and cannot be attributed to changes in parity over time.

Abstract LB-170: Breast cancer incidence and hormone therapy use before and after the Women’s Health Initiative (WHI) estrogen (E) plus progestin (P) trial by race/ethnicity

Abstract We examined breast cancer incidence in US women, 50 years or older, from the Surveillance, Epidemiology and End Results (SEER) program through 2015 in relation to estrogen (E) plus progestin (P) and E alone use before and after 2002, when adverse E plus P breast cancer effects in the WHI trial were initially reported. Age-adjusted annual breast cancer incidence rates for all US women averaged over the five-year intervals of 1983-1987, 1988-1992, 1993-1997, 1998-2002, 2003-2007, 2008-2012, 2013-2015 (3 year interval) were 330, 358, 368, 387, 345, 352 and 357 breast cancers per 100,000 women. After early quinquennial-to-quinquennial interval increases in breast cancer incidence, the surprising and sustained reduction in breast cancer incidence rates seen beginning in 2003 (Ravdin et al NEJM 2007) has been largely attributed to the substantial (70%) reduction in E plus P use over the same period (Jewett et al Obstet Gynecol 2014). However, differences in breast cancer incidence trends by race/ethnicity have emerged. Over the same quinquennial intervals, among White women, there were 343, 374, 383, 407, 359, 362 and 367 breast cancers per 100,000 women, following the same pattern of increases followed by sustained decrease beginning in 2003. In contrast, Black women experienced no substantial reduction in breast cancer incidence after 2003 with subsequent sustained increases through 2015 with quinquennial intervals rates of 277, 302, 327, 329, 328, 350, 356 breast cancers per 100,000 women with most recent incidence rates now comparable to White women. Based on reported findings of the WHI hormone therapy clinical trials and the sustained reduction seen in the US for both E plus P and E alone use (the latter for women with prior hysterectomy), we propose a hypothesis that the discordant trends in breast cancer incidence between White and Black women can largely be explained by the sustained changes in hormone therapy use beginning in 2003. In the WHI randomized trials, E plus P and E alone had opposite effects on breast cancer risk, E plus P initiation increasing breast cancer risk, further increasing with duration, with increased risk sustained for over a decade following cessation, and E alone decreasing risk at initiation and cessation (Chlebowski et al JAMA Oncology 2015). In 2003, E plus P use was higher in White compared to Black women. Thus, the reduction in E plus P use, cessation and decreased imitation, in White women was associated with prolonged reduction in breast cancer incidence. In contrast, with hysterectomy more common in Black women, decisions not to initiate E alone use could have increased their breast cancer risk. Thus, consideration of differential use of these two hormone regimens in Black and White women provides a plausible explanation for differential changes in breast cancer incidence seen in these two populations over recent quinquennial periods. Citation Format: Rowan T. Chlebowski, Aaron K. Aragaki, Garnet L. Anderson, Ross L. Prentice. Breast cancer incidence and hormone therapy use before and after the Women’s Health Initiative (WHI) estrogen (E) plus progestin (P) trial by race/ethnicity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-170.

Retrospective cohort study of breast cancer incidence, health service use and outcomes in Europe: a study of feasibility.

Comparisons of outcomes of health care in different systems can be used to inform health policy. The EuroHOPE (European Healthcare Outcomes, Performance and Efficiency) project investigated the feasibility of comparing routine data on selected conditions including breast cancer across participating European countries. Routine data on incidence, treatment and mortality by age and clinical characteristics for breast cancer in women over 24 years of age were obtained (for a calendar year) from linked hospital discharge records, cancer and death registers from Finland, the Turin metropolitan area, Scotland and Sweden (all 2005), Hungary (2006) and Norway (2009). Age-adjusted breast cancer incidence and 1-year survival were estimated for each country/region. In total, 24 576 invasive breast cancer cases were identified from cancer registries from over 13 million women. Age-adjusted incidence ranged from 151.1 (95%CI 147.2-155.0) in Hungary to 234.7 (95%CI 227.4-242.0)/100 000 in Scotland. One-year survival ranged from 94.1% (95%CI 93.5-94.7%) in Scotland to 97.1% (95%CI 96.2-98.1%) in Italy. Scotland had the highest proportions of poor prognostic factors in terms of tumour size, nodal status and metastases. Significant variations in data completeness for prognostic factors prevented adjustment for case mix. Incidence of and survival from breast cancer showed large differences between countries. Substantial improvements in the use of internationally recognised common terminology, standardised data coding and data completeness for prognostic indicators are required before international comparisons of routine data can be used to inform health policy.

Abstract B33: Female breast cancer in New England: Incidence, mortality, and prevention trends with attention to potential cancer racial/ethnic differences

Abstract Introduction: Breast cancer is estimated to be the first leading cancer type in incidence and the second leading cancer type in mortality in women in 2011 in the United States (US). In addition to the clinical breast exam, an annual mammogram is recommended as a breast cancer screening test. Cancer racial/ethnic disparities are defined as differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific racial/ethnic population groups in the US. The objectives of this study are: 1) to describe female breast cancer incidence, mortality, and mammogram use annual trends in New England; and 2) to evaluate potential female breast cancer racial/ethnic disparities in New England. Methods: Age-adjusted invasive breast cancer incidence rates in women were collected for 2004-2008 from the North American Association of Cancer Registries. Age-adjusted breast cancer mortality rates in women were collected for 2002-2006 from the Centers for Disease Control and Prevention (CDC). Mammogram use within the past 2 years, by women age 40+ or 50+, data were collected for 2000-2010 from the CDC. Results: Invasive female breast cancer shows an increasing incidence trend in Massachusetts (MA) and Rhode Island (RI), decreasing incidence trend in Maine, and stable incidence trend in Connecticut (CT), New Hampshire (NH), and Vermont. Nationwide, New England states rank among the top 10 US states in invasive female breast cancer incidence rate. In terms of race/ethnicity, non-Hispanic Blacks from RI show an increasing incidence trend of invasive female breast cancer, compared with non-Hispanic Blacks from CT, MA, and US. In addition, there is a decreasing female breast cancer mortality trend in non-Hispanic Whites from NH. The mammogram use analysis shows that VT has the lowest percentage of women having it within the past 2 years in New England and the percentage of women who have had it within the same time period is decreasing in RI. In general, 50+ women have had a mammogram within the past 2 years at a higher percentage than 40+ women. Conclusions: MA, CT, RI, and NH lead the US states in invasive female breast cancer incidence. These results suggest state or regional-specific conditions that need to be addressed. Further studies of female breast cancer racial/ethnic disparities in New England are needed. Finally, mammogram use increases with age. However, its use should be further encouraged among women in New England. Funding: National Institutes of Health, National Cancer Institute Research Supplement to Promote Diversity in Health-related Research (PI Brian C. Lewis, PhD, University of Massachusetts Medical School, Worcester, MA). Citation Format: Wilfredo Eugenio De Jesus-Monge, Vivianna Margarita De Jesus-Monge. Female breast cancer in New England: Incidence, mortality, and prevention trends with attention to potential cancer racial/ethnic differences. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B33. doi:10.1158/1538-7755.DISP13-B33

Escalating burden of breast cancer in southern Thailand: Analysis of 1990–2010 incidence and prediction of future trends

BackgroundThailand is undergoing an epidemiologic transition, with decreasing incidence of infectious diseases and increasing rates of chronic conditions, including cancer. Breast cancer has the highest incidence rates among females both in the southern region Thailand and throughout Thailand. However, there is a lack of research on the epidemiology of this and other cancers. MethodsHere we use cancer incidence data from the Songkhla Cancer Registry to characterize and analyze the incidence of breast cancer in Southern Thailand. We use joinpoint analysis, age-period-cohort models and nordpred analysis to investigate the incidence of breast cancer in Southern Thailand from 1990 to 2010 and project future trends from 2010 to 2029. ResultsWe found that age-adjusted breast cancer incidence rates in Southern Thailand increased by almost 300% from 1990 to 2010 going from 10.0 to 27.8 cases per 100,000 person-years. Both period and cohort effects played a role in shaping the increase in incidence. Three distinct incidence projection methods consistently suggested that incidence rates will continue to increase in the future with incidence for women age 50 and above increasing at a higher rate than for women below 50. ConclusionsTo date, this is the first study to examine Thai breast cancer incidence from a regional registry. This study provides a basis for future planning strategies in breast cancer prevention and to guide hypotheses for population-based epidemiologic research in Thailand.

Abstract P1-09-06: Breast cancer in the Pan-American region: Inequities in incidence and mortality rates according to the human development index

Abstract Background: Breast cancer (BC) is considered a public health problem in countries of the Pan-American Health Organization (PAHO). Data from GLOBOCAN 2008 shows BC age-adjusted incidence and mortality rates of 57.1 and 13.7 per 100,000 inhabitants in the region. The aim of the present study is to evaluate the association between BC incidence and mortality rates with the human development index (HDI) in PAHO countries. Methods: This is an ecological analysis including 29 countries (PAHO) with reported data both in GLOBOCAN 2008 and in the 2013 United Nation Development Reports (UNDP). In alphabetical order the participant countries were Argentina, Bahamas, Barbados, Belize, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, United States of America, Uruguay and Venezuela. HDI is a composite statistic of life expectancy, education, and income and was analyzed as a continuous score. Age-adjusted BC incidence and mortality rates were taken from GLOBOCAN 2008 and log-transformed due to skewness. Pearson correlation and simple linear regression were performed using Stata 12 (Stata Corp., College Station, USA). Results: A positive correlation was found between HDI and log-transformed age-adjusted BC incidence and mortality rates. The correlation coefficient between HDI and BC incidence rate was 0.68 (p-value&amp;lt;0.001). The correlation with BC mortality rate was 0.49 (p-value = 0.007). Linear regression showed that an increase in one HDI unit lead to a gain of 3.51 points (se = 0.72; p-value&amp;lt;0.001) in the incidence rate and 2.14 points (se = 0.73; p&amp;lt;0.007) in the mortality rate. Conclusion: HDI inequities are important and should be considered in the analysis of the difference in BC incidence and mortality rates seen in PAHO countries. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-06.

Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Breast Carcinoma in Young Women

To estimate the incidence of breast carcinoma and survival in patients younger than 25 years old, and to describe presenting clinical signs and symptoms of breast cancer in this age group. A population-based descriptive study and case review in Olmsted County, Minnesota, was conducted using the resources of the Rochester Epidemiology Project. Participants were Olmsted County girls and women younger than 25 years old with histopathologically confirmed breast carcinoma diagnosed between 1935 and 2005. Nonresidents who presented to a medical facility within Olmsted County during this time period were included in some portions of the analysis. Main outcome measures were age-adjusted incidence, 5-year survival, and clinical presentation of breast carcinoma in girls and women younger than 25 years of age. With four breast carcinomas observed in Olmsted County residents over 1,201,539 person-years, the annual age-adjusted incidence of breast cancer in this population was 3.2 per million (95% confidence interval, 0.1-6.2). All four cancers occurred in the 20- to 24-year age group (age-specific incidence, 16.2 per million). Eight additional cases of breast carcinoma were identified in nonresidents. Delay in diagnosis was common. All had at least one feature worrisome for an aggressive neoplasm identified in their clinical history, on physical examination or by imaging. Breast carcinoma in young women is very rare, associated with delayed diagnosis, and usually associated with concerning features requiring biopsy. III.

Abstract 3714: Breast cancer trends in Israeli Jewish and Arab women 1996-2007

Abstract Background: Breast cancer is the most common malignancy in Israeli Jewish and Arab women, but the disease trends in these two population groups have not been re-examined in recent years. The Israel National Cancer Registry (INCR) and the Israel Center for Disease Control (ICDC) collaborate to provide periodic population-based summary data on cancer incidence, mortality and survival. Methods: Data were obtained from the INCR, the ICDC and the National Bureau of Statistics. The rates presented are age-adjusted to the world standard population. Time trends are presented using the moving average method. Relative survival (i.e., observed survival among cancer patients divided by the expected survival in the general population with the same age, sex and ethnicity distribution) was calculated for the diagnosis years 1996-2003. Data from the Knowledge, Attitudes and Practices (KAP) surveys carried out in 2000, 2002, 2004, 2006 and 2008 were analyzed to determine proportions of women that reported undergoing a screening mammogram in the previous two years. Results: From 1996 through 2007, age-adjusted breast cancer incidence rates (per 100,000) increased from 96.7 to 99.8 (3%, ns*) in Jewish women and from 38.6 to 79.2 (105%, p=0.0001) in Arab women. The p-value for between-populations trend differences (p-value ‘between′) was &amp;lt;0.0001. For invasive tumors only, the corresponding change estimates are -3% (p=0.035) for Jewish women and 98% (p=0.0001) for Arab women (p-value ‘between’ &amp;lt;0.0001). In 1996, 10% and 7% of all newly diagnosed breast tumors in Jewish and Arab women, respectively, were in-situ. In 2007 the corresponding proportions were 17% and 11%, respectively (p=0.61). Data from the KAP surveys in the 50- to 74-year age group indicated that between 2000 and 2008, reports of having had a screening mammogram in the last two years increased by 29% and by 40% in Jewish and Arab women, respectively (p=0.58). Mortality rates (per 100,000) from breast cancer decreased for Jewish women from 24.7 in 1996 to 19.0 in 2007 (p=0.001). In Arab women the rates were stable with a non significant change: 17.1 in 1996 and 17.9 in 2007 (p-value ‘between’ = 0.041). Five-year relative survival among Jewish breast cancer patients increased from 83% in 1996 to 88% in 2003 (p=0.006). The corresponding survival measures for Arab patients increased non-significantly from 66% in those diagnosed in 1996 to 78% in those diagnosed in 2003 (p-value ‘between’ =0.42). Conclusions: Breast cancer incidence is stable in Jewish women but rapidly increasing in Arab women throughout 1996-2007; the well-documented incidence gap in these groups is narrowing. Significant time trend differences were observed for the diagnosis of invasive tumors (greater increase in Arab compared to Jewish women) and breast cancer mortality (no decrease in Arab women compared to a moderate decrease in Jewish women) but not for relative survival, mammography use and early stage diagnosis. *ns=non-significant Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3714. doi:10.1158/1538-7445.AM2011-3714

Persistence in breast cancer disparities between African Americans and whites in Wisconsin.

Breast cancer (BC) mortality is higher in African American women compared to white women despite having a lower incidence. The reasons for this remain unclear, despite decades of research. Reducing BC health disparities is a priority but has had limited success. To assess progress in eliminating breast cancer-related health disparities in Wisconsin by comparing trends in breast cancer outcomes in African American and white women from 1995 to 2006 and comparing results nationally. Age-adjusted breast cancer (BC) incidence and stage data from the Wisconsin Cancer Reporting System and age-adjusted mortality data from National Center of Health Statistics were used to evaluate trends in incidence and mortality from 1995 to 2006 for African Americans and whites. The relative disparity was evaluated by rate ratios. Trends in distribution of in situ vs malignant disease were examined. National trend data were obtained from the National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) database. Age-adjusted incidence decreased 10% in Wisconsin compared to 7% nationally. Incidence of BC was lower in African American compared to white women. BC mortality in African American women declined in Wisconsin, but remained higher than white females. Age-adjusted mortality in Wisconsin declined approximately 23%, matching national trends. Non age-adjusted stage data trended toward a decrease in malignant, but increased in situ disease. Despite an overall reduction in BC mortality from 1995 to 2006, a persistent disparity in mortality remains for African American women, demonstrating no significant progress in reducing BC health disparities.

Abstract A82: The FTO obesity gene and the risk of postmenopausal breast cancer among the medically underserved population in rural Pennsylvania

Abstract Purpose: Among all the established risk factors for postmenopausal breast cancer (PMBC), obesity, with 21 % risk, accounts for the largest share of potentially modifiable population attributable risk (PAR). The risk of PMBC from obesity is multifactorial and includes genetic, behavioral and environmental influences. Of all the genes associated with obesity, FTO has the highest risk (RR=1.67) and greatest PAR (&amp;gt; 20%), in the white European population. The risk of human adiposity has been associated with allele A (Adenine) in SNP rs9939609, and G (Guanine) in SNP rs1477196 and T(Thymidine) in SNP rs1861868. Central and northeastern counties in Pennsylvania (PA), of which 75% has been designates as medically underserved, is home to a relatively homogenous population of white European ancestry. This region experiences significantly above the national average age-adjusted breast cancer incidence and high prevalence of obesity. Elimination of health disparities across different segments of population is one of the objectives of the Healthy People of 2010. The notion of health disparities implies that the disease-specific risk for different sub-populations should be identified and resources should be allocated accordingly. Research on the genetic susceptibility of PMBC from obesity has been inconclusive. Therefore, we conducted a retrospective study with the primary objective of assessing prevalence of three SNPs [rs9939609, rs1861868, and rs1477196] of the FTO gene in group of women diagnosed with invasive breast cancer and their age-matched controls. Methods: The study benefits from an ongoing population-based biobanking project entitled “MyCode” at the GHS. A total of 201 women diagnosed with invasive breast cancer have donated blood samples to the project constitute the cases. Controls were 603 women with no medical history of breast cancer, who have also participated in the biobanking. SNPs have been genotyped using ABI TaqMan assays. Clinical and demographic data have been retrieved from medical records. Measures of associations were estimated using non-parametric statistics. All statistical analyses were performed using SAS v. 9.1 (SAS Institute, Cary, NC). Results: So far genotyping has been completed for a total of 50 cases and 99 controls with the mean age of 66 (±12) and 64 (±11) (P=.49) years, respectively. The difference in mean BMI between cases (32.23 ±7.23) and controls (33.52 ± 8.80) did not reach the level of statistical significance. Of the three SNPs, the SNP rs9939609 yielded a potential association with PMBC (OR= 2.04,95% CI .96-4.34, P=.0653). Conclusions: Preliminary findings suggest that one of the SNPs of FTO might increase the risk of PMBC. The FTO gene, in addition to its role in human adiposity, has been reported to encode a protein that is a member of the non-heme dioxygenase super family, involved in DNA repair pathway by reversing of alkylated damages to DNA and RNA. Discerning the association between the common SNPs of the FTO gene and PMBC offers the potential to identify at risk women that could benefit from targeted intervention strategies to reduce their risk of PMBC. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A82.

Could Recent Decreases in Breast Cancer Incidence Really Be Due to Lower HRT Use? Trends in Attributable Risk for Modifiable Breast Cancer Risk Factors in Canadian Women

Objectives: Recent downward trends in breast cancer incidence have been attributed to declining use of hormone replacement therapy (HRT). To determine whether this is a credible conclusion, this study calculated population attributable risk (PAR) for HRT and other modifiable breast cancer risk factors. Methods: PAR calculation needs both the prevalence of a risk factor, and the relative risk (RR) for breast cancer incidence for that risk factor. Prevalences were calculated for Canadian women, aged 50-69, participating in the National Population Health Survey, 1994-2006. RR were derived from published research: 1.4 for HRT use, 1.4 for excessive alcohol use, 1.15 for physical inactivity, 1.25 for smoking, 1.4 for BMI over 30 kg/m2. Trends for PAR were calculated for the risk factors separately, as well as combined. Age-adjusted breast cancer incidence rates were calculated for Canadian women aged 50-69 for the years 1994-2004. Results: Between 1998 and 2004, PAR for HRT decreased by 50%. PAR for other risk factors showed only small changes, and the combined PAR decreased by 18.6%. Age-adjusted breast cancer incidence for women aged 50-69 peaked in 2000 at 330.0/100,000, then dropped by 17.2% by 2004. Conclusion: Patterns of PAR for HRT use in Canada are consistent with the noticeable decrease in breast cancer incidence observed for women of the same age group. Combining PAR for all risk factors indicated that changes in HRT use overpowered any trends of other risk factors. The combined PAR suggest that alterations in lifestyle could have considerable impact on breast cancer incidence. Key words: Breast cancer incidence; population attributable risk; hormone replacement therapy; alcohol; physical activity; obesity

Impact of mobile mammography among the medically underserved.

e12027 Background: Mammography has been established as the primary screening tool for breast cancer. The decline in the number of FDA-approved stationary mammography units has resulted in a significant proportion of counties in rural states without a single unit. Mobile mammography has the potential to enhance access to mammography among the medical underserved. This report describes the use of a mobile modular mammography unit in Arkansas. Methods: From 2003-2007, a modular mammography unit traveled to 28 counties, 21 of which lacked a stationary unit. The number of mammograms performed and their outcomes were collected at each visit. Demographic information, health insurance status and previous mammography use were captured. Results: The modular unit made 179 day-long visits and performed 2427 mammograms for an average of 13.6 mammograms per visit. Of the 2427 mammograms performed, 1619 (67%) were normal and 808 (33%) required additional views. Ninety-four patients (4%) required biopsies and 4 (0.16%) were diagnosed with ductal carcinoma in situ (DCIS). One-third of participants were African-American; 2% were Hispanic; and the remainder were Caucasian. Most had some form of health insurance: private (24%), Medicare (37%), Medicaid (7%), or Breast Care (30%), a state-run program to provide mammograms to low-income women. The average age was 57 years and most (77%) had previously had a mammogram. Counties served by the unit were medically underserved with 57 physicians per 100,000 population in comparison to a nationwide rate of 297 per 100,000, and 75% lived in rural areas. Conclusions: The modular unit enhanced access to mammography among those whose ability to obtain a mammogram was limited by geographic location or socioeconomic factors. The rate of detection of DCIS was 1.60 per 100,000 women screened, a rate slightly higher than the age-adjusted breast cancer incidence rate in Arkansas of 1.17 per 100,000. Early detection by mobile mammography has the potential to reduce the morbidity, mortality and treatment cost among the medically underserved. No significant financial relationships to disclose.