Decreasing Incidence of Estrogen Receptor–Negative Breast Cancer in the United States: Trends by Race and Region

Abstract

Background Incidence of estrogen receptor (ER)-negative breast cancer, an aggressive subtype, is highest in United States (US) African American women and in southern residents but has decreased overall since 1992. We assessed whether ER-negative breast cancer is decreasing in all age groups and cancer registries among non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic White (HW) women. Methods We analyzed 17 Surveillance, Epidemiology, and End-Results Program registries (twelve for 1992-2016; five for 2000-2016) to assess NHW, NHB, and HW trends by ER status and age group (30-39, 40-49, 50-69, 70-84 years). We used hierarchical age-period-cohort models that account for sparse data, which improve estimates to quantify between-registry heterogeneity in mean incidence rates and age-adjusted trends versus SEER overall. Results Overall, ER-negative incidence was highest in NHB, then NHW and HW women, and decreased from 1992-2016 in each age group and racial/ethnic group. The greatest decrease was for HW women ages 40-49 years with an annual percent change of –3.5%/year (95% credible interval = −4.4%, −2.7%), averaged over registries. The trend heterogeneity was statistically significant in every race/ethnic and age group. Furthermore, the incidence relative risks by race/ethnicity compared to the race-specific SEER average were also statistically significantly heterogeneous across the majority of registries and age groups (62 of 68 strata). The greatest heterogeneity was seen in HW women, followed by NHB women, and the least in NHW women. Conclusion Decreasing ER-negative breast cancer incidence differs meaningfully by US region and age among NHB and HW women. Analytical studies including minority women from higher and lower incidence areas may provide insights into breast cancer racial disparities.

Breast Cancer Statistics, 2022

“…Since 2004, invasive breast cancer incidence has risen slowly by 0.5% per year, 4,9,46 which a recent ecologic study attributes to increases in body mass index and continued declines in the fertility rate 47 . Body mass index and reproductive factors primarily influence risk for hormone receptor‐positive tumors, which are reported (and shown herein) to be driving the increase 48,49 …”

Temporal trends in Black‐White disparities in cancer surgery and cancer‐specific survival in the United States between 2007 and 2015

“…Moreover, in the case of breast cancer, where there is a persistent disparity between Black and White women, mammography rates for Black women are still significantly lower than for White women. 48 , 49 This might be related to Black women's underinsurance or lack of coverage for medical expenses. More than 11% of non‐elderly Black people are uninsured, compared with about 8% of non‐elderly White people, according to the Kaiser Family Foundation.…”

“…Delayed treatment time is associated with increased disease‐specific and overall mortality. Moreover, in the case of breast cancer, where there is a persistent disparity between Black and White women, mammography rates for Black women are still significantly lower than for White women 48,49 . This might be related to Black women's underinsurance or lack of coverage for medical expenses.…”

Race, Class, and Place Modify Mortality Rates for the Leading Causes of Death in the United States, 1999–2021

“…Even high-quality efforts to investigate US health disparities tend to consider one or two of these at a time, rather than adjusting simultaneously for all three. [2][3][4][5] In cases where all three are considered, researchers tend to focus on only one or a few causes of death. 6,7 Thus, less is known about how these three fundamental drivers of health disparities will contribute jointly to mortality, nor is it known how these drivers differ by cause of death.…”