Significant Difference in the Trends of Female Breast Cancer Incidence Between Taiwanese and Caucasian Americans: Implications from Age-Period-Cohort Analysis

Abstract

Female invasive breast cancer (FIBC) in Taiwan is characterized by a striking recent increase of incidence and a relatively young median age (45-49 years) at diagnosis. The Westernization of lifestyle that is increasingly affecting younger generations of Taiwanese may have an important impact on this change. We compared epidemiologic data on FIBC in Taiwanese obtained from the Taiwan Cancer Registry with data for Caucasian Americans obtained from the database of the Surveillance, Epidemiology, and End Results Program for the period from 1980 to 1999. Agespecific incidence rates of FIBC were plotted by calendar year at diagnosis and by birth cohort for both populations. The individual effects of time period and birth cohort on the incidence trends of FIBC in both populations were evaluated using the age-period-cohort analysis. The incidence rate of FIBC was continuously increased in Taiwanese throughout the past 2 decades, whereas the increase of incidence was slowing down in Caucasian Americans. The incidence rates in Taiwanese women born after the 1960s were approaching that of Caucasian Americans. The age-period-cohort analysis showed a much stronger birth cohort effect on the incidence trend of FIBC in Taiwanese than in Caucasian Americans. This strong birth cohort effect corresponded to the Westernization of lifestyle in Taiwan since 1960. These findings indicate that a continued shift in the incidence and age distribution pattern of FIBC in Taiwanese toward that of Caucasian Americans should be anticipated. (Cancer Epidemiol Biomarkers Prev 2005;14(8):1986 -90)

Differences in Incidence, Mortality and Survival of Breast Cancer by Regions and Countries in Asia and Contributing Factors

“…Asian women were about 6-18 years younger at breast cancer diagnosis than non-Hispanic whites (median age 63), and are younger than Asians (median age 56) in the United States (Yi et al, 2012). It has been suggested that the early onset of Asian women is explained by an age-period-cohort effect: the rapid change of breast cancer risk profiles allied to westernized lifestyle such as low parity, insufficient breastfeeding, and weight gain are observed among younger and more recently born women, which have resulted in a higher increase of breast cancer in the generation (Minami et al, 2004;Chia et al, 2005;Shen et al, 2005;Dhillon et al, 2011;MousaviJarrrahi et al, 2013).…”

Association between mitochondrial DNA 4,977 bp deletion and NAD(P)H:quinone oxidoreductase 1 C609T polymorphism in human breast tissues

“…According to the epidemiologic studies, prolonged exposure to estrogen, including reduced fertility rate, earlier menarche, and prolonged reproductive stimulation in the lifetimes, is significantly associated with increased risk of female breast cancer in Taiwan and in Western countries (28,29). The oxidized metabolites of estrogen, E2-3,4-semiquinones and E2-3,4-quinones, have been shown to bind to DNA to form adducts, leading to genetic damage.…”

Multimodel assessment of BRCA1 mutations in Taiwanese (ethnic Chinese) women with early-onset, bilateral or familial breast cancer

“…First, the median age of breast cancer patients in Taiwan (45-49 years) is lesser than that in Western countries (70-74 years). 2 Second, a rise in incidence has been observed consistently in Asian countries, [2][3][4] and one age-period-cohort analysis showed that the increase in breast cancer incidence was largely due to a rise in young patients. 2 Third, a longitudinal cohort revealed that young breast cancer patients in Taiwan carried a greater risk for and shorter interval to progression to secondary contralateral primary breast cancer than in western women.…”

“…2 Second, a rise in incidence has been observed consistently in Asian countries, [2][3][4] and one age-period-cohort analysis showed that the increase in breast cancer incidence was largely due to a rise in young patients. 2 Third, a longitudinal cohort revealed that young breast cancer patients in Taiwan carried a greater risk for and shorter interval to progression to secondary contralateral primary breast cancer than in western women. 5,6 As the young age and bilateral breast cancer are more likely to be related to genetic predisposal of factors, 7,8 it is important to identify potential predisposing factors in Taiwanese patients.…”