UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Medline ® Abstracts for References 7-11

of 'Clinical features, diagnosis, and staging of newly diagnosed breast cancer'

7
TI
The decrease in breast-cancer incidence in 2003 in the United States.
AU
Ravdin PM, Cronin KA, Howlader N, Berg CD, Chlebowski RT, Feuer EJ, Edwards BK, Berry DA
SO
N Engl J Med. 2007;356(16):1670.
 
An initial analysis of data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries shows that the age-adjusted incidence rate of breast cancer in women in the United States fell sharply (by 6.7%) in 2003, as compared with the rate in 2002. Data from 2004 showed a leveling off relative to the 2003 rate, with little additional decrease. Regression analysis showed that the decrease began in mid-2002 and had begun to level off by mid-2003. A comparison of incidence rates in 2001 with those in 2004 (omitting the years in which the incidence was changing) showed that the decrease in annual age-adjusted incidence was 8.6% (95% confidence interval [CI], 6.8 to 10.4). The decrease was evident only in women who were 50 years of age or older and was more evident in cancers that were estrogen-receptor-positive than in those that were estrogen-receptor-negative. The decrease in breast-cancer incidence seems to be temporally related to the first report of the Women's Health Initiative and the ensuing drop in the use of hormone-replacement therapy among postmenopausal women in the United States. The contributions of other causes to the change in incidence seem less likely to have played a major role but have not been excluded.
AD
Department of Biostatistics, M.D. Anderson Cancer Center, Houston, USA.
PMID
8
TI
Reported drop in mammography : is this cause for concern?
AU
Breen N, A Cronin K, Meissner HI, Taplin SH, Tangka FK, Tiro JA, McNeel TS
SO
Cancer. 2007;109(12):2405.
 
BACKGROUND: Timely screening with mammography can prevent a substantial number of deaths from breast cancer. The objective of this brief was to ascertain whether recent use of mammography has dropped nationally.
METHODS: The authors assessed the trend in mammography rates from 1987 through 2005. Then, they used the 2000 and 2005 National Health Interview Survey (NHIS) estimates to characterize trends and current patterns in mammography use.
RESULTS: After robust, rapid increases in reported use of mammography by women in the U.S. since 1987, estimates from the 2005 NHIS showed a decline compared with 2000 (from 70% to 66%). Although it was small, this decline may be cause for concern, because it signals a change in direction.
CONCLUSIONS: This report establishes for the nation what already has been observed in some local data. The results confirmed that the use of mammography may be falling. This change needs to be monitored carefully and also may call for intervention.
AD
Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda 20892-7344, Maryland, USA. breenn@mail.nih.gov
PMID
9
TI
Breast cancer incidence, 1980-2006: combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status.
AU
Glass AG, Lacey JV Jr, Carreon JD, Hoover RN
SO
J Natl Cancer Inst. 2007;99(15):1152. Epub 2007 Jul 24.
 
BACKGROUND: Breast cancer incidence has been rising since at least 1935-1939, but recent US data reveal a statistically significant decline in breast cancer incidence in 2003 that persisted through 2004. Identifying the specific contributions of the potential causes of this long-term increase and the recent decrease in incidence has been challenging. Marked changes in rates of mammography screening and use of menopausal hormone therapy since 1980 have added further complexity. We examined the potential association between menopausal hormone therapy use and recent changes in breast cancer incidence.
METHODS: Using tumor registry, clinical, pathology, and pharmacy data from Kaiser Permanente Northwest, a large prepaid US health plan, we compared age-specific and age-adjusted breast cancer incidence rates (2-year moving averages) with use of screening mammography and dispensed menopausal hormone therapy prescriptions between 1980 and 2006. Temporal changes in incidence rates were assessed via joinpoint regression.
RESULTS: A total of 7386 incident invasive breast cancers were diagnosed in plan members from 1980 through 2006. Overall age-adjusted breast cancer incidence rates per 100,000 women rose 25% from the early 1980s (105.6) to 1992-1993 (131.7) and an additional 15% through 2000-2001 (151.3), then dropped by 18% to 2003-2004 (123.6) and edged up slightly in 2005-2006 (126.2). These patterns were largely restricted to women aged 45 years or older and to estrogen receptor-positive (ER+) breast cancers. Incidence rates of ER-negative tumors experienced neither of the rises seen for ER+ tumors but also fell precipitously from 2003 through 2006. Rates of mammography screening sharply increased from 1980 to 1993 but then leveled off, and 75%-79% of women aged 45 years or older received a mammogram at least once every 2 years from 1993 through 2006. Menopausal hormone therapy dispensings, particularly of estrogen-plus-progestin formulations, increased from 1988 to 2002 but then dropped by approximately 75% after 2002.
CONCLUSIONS: From 1980 through 2006, quantitative and qualitative trends in breast cancer incidence rates, particularly for ER+ tumors, parallel major changes in patterns of mammography screening and use of menopausal hormone therapy.
AD
Oncology Research, Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA. andrew.glass@kpchr.org
PMID
10
TI
Regional changes in hormone therapy use and breast cancer incidence in California from 2001 to 2004.
AU
Robbins AS, Clarke CA
SO
J Clin Oncol. 2007;25(23):3437.
 
PURPOSE: Recently, an unprecedented 1-year 7% decrease in the overall incidence of invasive female breast cancer in the United States was reported. It has been suggested that the decrease resulted from the mass cessation of estrogen-progestin hormone therapy (EPHT) in 2002. We took advantage of California's unique population-based cancer surveillance resources to assess whether regional changes in breast cancer incidence observed between 2001 and 2004 correlated with regional changes in EPHT use between 2001 and 2003.
METHODS: We obtained statewide cancer registry and California Health Interview Survey (CHIS) EPHT data for almost 3 million non-Hispanic white women age 45 to 74 years, residing in California's 58 counties. We examined trends in the age-adjusted incidence of invasive female breast cancer and compared these with trends in the use of EPHT, after grouping all California counties into three groups based on EPHT use in 2001. We also examined CHIS data on trends in screening mammography. Results In 2001, there were large regional differences in EPHT use and breast cancer incidence. From 2001 to 2004, incidence declined by 8.8% in the counties with the smallest EPHT reductions, by 13.9% in those with intermediate reductions, and by 22.6% in countieswith the largest EPHT reductions. Between 2001 and 2003, CHIS data did not show any significant change in the proportion of women who reported having a mammogram in the previous 2 years.
CONCLUSION: These data support the hypothesis that changes in EPHT use in 2002 may be responsible for significant declines in breast cancer incidence between 2002 and 2003 and sustained through 2004.
AD
California Cancer Registry, Public Health Institute, 1700 Tribute Rd, Suite 100, Sacramento, CA 95815, USA. arobbins@ccr.ca.gov
PMID
11
TI
Trends in breast cancer incidence and mortality in the United States: implications for prevention.
AU
Toriola AT, Colditz GA
SO
Breast Cancer Res Treat. 2013 Apr;138(3):665-73. Epub 2013 Apr 2.
 
While debate continues regarding short-term changes in breast cancer incidence and the impact of screening on mortality, a long-term view of trends in incidence and mortality may better inform our understanding of the changing patterns of disease and ultimately guide in population-based prevention. Although many factors have influenced breast cancer incidence over the past seven decades, some have played more prominent roles at various times. Changing reproductive patterns, greater longevity, and post-menopausal hormone (estrogen + progesterone) were important in the steady increase before 1980, while mammographic screening, probably in conjunction with escalating combined estrogen + progesterone use, played dominant roles in the post-1980 surge. Accruing evidence also indicates that the rapid drop in 2003 was mostly due to a sharp decline in estrogen + progesterone use. The most paradoxical observation relates to the divergence in incidence and mortality trends most noticeable when mortality rates started to decline shortly after the surge in incidence rates started in 1980. In addition to the dynamic changes in risk factor profiles, the divergence reflects wider uptake of screening mammography, better characterization of tumor biology,and improvements in treatment. The rise in incidence rates over the past three decades is due to an increase in estrogen receptor positive (ER+) tumors, which respond favorably to treatment. On the other hand, the incidence of estrogen receptor negative (ER-) tumors, which respond poorly to hormonal therapy, has been decreasing for almost three decades. Furthermore, widespread adoption of screening mammography has led to tumors being diagnosed at earlier stages when treatment is effective and advances in treatment have ensured adoption of targeted and better tolerated therapies. To achieve long-term success in the primary prevention of breast cancer, a greater understanding of factors responsible for the decrease in ER- tumors is essential. In addition, improving the sensitivity of breast cancer screening to facilitate earlier detection of tumors with very aggressive phenotypes would go a long way in bridging the divergence between incidence and mortality.
AD
Division of Public Health Sciences, and Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA, a.toriola@wustl.edu.
PMID