Recent time trends in breast cancer incidence

The appearance of the third volume of “Cancer Incidence in Five Continents” made it possible to study time trends of cancer incidence. The registered age-standardized incidence of breast cancer has increased in almost all countries. Some populations in whom the rise has been steep (Iceland, Israel's Sabras, Hawaii Japanese) have been analyzed on an age-specific basis with particular attention to changes in successive cohorts. In the Hawaii Japanese there is evidence that the rise in incidence is largely confined to cohorts born after 1905, viz. nisei who grew up in an American environment. It is pointed out that under these circumstances an increase in body height occurred which set the stage for a new somatotype with taller and heavier people. A combination of increased weight and height has been shown to increase the risk of breast cancer in various populations, inter alia the Japanese, in the peri- and postmenopausal period. The hypothesis that increased height played a part in the new epidemic among Hawaii Japanese explains why the incidence rose cohort-wise and has shown a long latency period since migration.     

Global trends in breast cancer incidence and mortality 1973-1997

BACKGROUND: Worldwide, breast cancer is the most common cancer and is the leading cause of cancer death among women. METHODS: To describe global trends, we compared age-adjusted incidence and mortality rates over three decades (from 1973-77 to 1993-97) and across several continents. RESULTS: Both breast cancer incidence and mortality rates varied 4-fold by geographic location between countries with the highest and lowest rates. Recent (1993-1997) incidence rates ranged from 27/100,000 in Asian countries to 97/100,000 among US white women. Overall, North American and northern European countries had the highest incidence rates of breast cancer; intermediate levels were reported in Western Europe, Oceania, Scandinavia, and Israel; and Eastern Europe, South and Latin America, and Asia had the lowest levels. Breast cancer incidence rose 30-40% from the 1970s to the 1990s in most countries, with the most marked increases among women aged > or =50 years. Mortality from breast cancer paralleled incidence: it was highest in the countries with the highest incidence rates (between 17/100,000 and 27/100,000), lowest in Latin America and Asia (7-14/100,000), and rose most rapidly in countries with the lowest rates. CONCLUSIONS: Breast cancer incidence and mortality rates remain highest in developed countries compared with developing countries, as a result of differential use of screening mammograms and disparities in lifestyle and hereditary factors. Future studies assessing the combined contributions of both environmental and hereditary factors may provide explanations for worldwide differences in incidence and mortality rates.     

Recent trends in hormone therapy utilization and breast cancer incidence rates in the high incidence population of Marin County,California

Background  

Recent declines in invasive breast cancer have been reported in the US, with many studies linking these declines to reductions in the use of combination estrogen/progestin hormone therapy (EPHT). We evaluated the changing use of postmenopausal hormone therapy, mammography screening rates, and the decline in breast cancer incidence specifically for Marin County, California, a population with historically elevated breast cancer incidence rates.     

Estimation of trends in cancer incidence in a population-based cancer registry

To evaluate trends in cancer incidence adjusted for completeness of registration in a population-based cancer registry, we analyzed the data of incidence and mortality in the Aichi Cancer Registry from 1979 to 1986 and recalculated age-adjusted incidence rates (AAIRs) at the lowest completeness of registration through the study period by excluding reported cases from the registration randomly. The results were as follows: 1) The AAIRs for male stomach cancer and rectal cancer in both sexes, which did not decrease or rather increased using the original incidence figures, showed a clear decrease after adjustment. 2) The AAIRs for female stomach and uterine cancers, which also showed decreases in the original incidence, showed more marked decreases. 3) The marked increases observed for the AAIRs for colon and breast cancers in the original incidence were attenuated by about 50%. 4) The AAIRs for liver and lung cancers were also affected somewhat by the adjustment for completeness of registration. 5) Trends in the AAIRs after adjusting for completeness of registration were virtually the same as those for age-adjusted mortality rates.     

Comparison of male and female breast cancer incidence trends, tumor characteristics, and survival

PURPOSE: To compare male and female breast cancer and to determine the predictors of tumor characteristics and survival in both genders. METHODS: Male (n = 2923) and female breast cancer cases (n = 442,500) from the Surveillance, Epidemiology and End Results (SEER) registry were analyzed. Joinpoint regression was performed to detect changes in incidence trends from 1973 to 2001. Multiple logistic regression was used to regress each of four outcome variables (STAGE, LATERALITY, ESTROGEN, and PROGESTERONE RECEPTOR STATUS) on four demographic variables. Cox proportional hazards regression modeling was used to determine significant predictors of death of breast cancer after adjusting for demographic factors. RESULTS: Both men and women aged less than 50 years were at higher risk for advanced breast cancers. Males were at higher risk than females for advanced tumors among non-whites. The risk of breast cancer death among all cases was lower for each 10-year increase in age by 2%, higher for those who are unmarried than for those who are married by 12% and 13% higher for non-whites than for whites. CONCLUSIONS: Some important gender differences were detected with respect to factors associated with tumor characteristics, but gender was not a significant predictor of survival after adjusting for the other demographic variables.     

Current trends in pharmacotherapy of breast cancer

INTRODUCTION: Breast cancer is a systemic disease, unfortunately clinically undetectable micrometastases are present in many women even in early stages of the disease. Many of these patients can be cured with combined modality treatment of surgery, radiation and chemo- or hormone therapy. AIM: To survey the treatment of breast cancer. METHOD: The author presents an overview of the treatment of breast cancer based on the relevant literature and experience. RESULTS: Systemic adjuvant treatments include cytotoxic and hormone therapy. The most commonly used cytotoxic agents are cyclophosphamide, methotrexate, 5-fluorouracil, doxorubicin and epirubicin. The anthracycline-containing regimens are slightly superior, and the addition of taxane to an anthracycline-containing regimen may further increase the efficacy of adjuvant chemotherapy. Patients with metastatic disease cannot be cured, the goal of the treatment is to improve quality of life, and prolong survival. Up to 60-80% of these patients may experience objective tumor response to first-line combination chemotherapy. The taxanes (paclitaxel or docetaxel) with anthracyclines are the most active chemotherapy drugs against breast cancer. The best results are achieved with second-, third-line chemotherapy drugs: capecitabine, vinorelbine, gemcitabine, 5-fluorouracil and a variety of its oral pro-drugs. The most recent developments are represented by the biologically-targeted drugs, the first agent developed trastuzumab, has already been introduced in the clinic. The combination of chemotherapy with various response modifiers is a rapidly developing field of clinical cancer research. Several other new agents including growth factor receptor antagonists, tumor vaccines, antiangiogenic agents are tested in clinical trials alone and in combination with chemotherapy. CONCLUSIONS: The combination of chemotherapy with the new generation of drugs is a rapidly advancing and important field of clinical oncology.     

Recent trends in the incidence of salivary gland cancer

Beginning in 1985, a sudden and sustained doubling of salivary gland cancer incidence, among men only, is observed in the San Francisco-Oakland Metropolitan Statistical Area. Registry data are examined to determine the nature of this increase and its possible association with the AIDS epidemic. Changes in patient characteristics are assessed by comparing their distribution among recently diagnosed cases (1985-1988) to an expectation based on population growth and the age-specific incidence among patients diagnosed earlier (1973-1984). Based on the observed patterns, it is unlikely that the temporal increase in these tumours is a direct result of the AIDS epidemic or solely the result of a shift in the prevalence of established risk factors. The increase is predominantly seen in men over the age of 75 at diagnosis (O/E = 2.3, p = 0.02) and is observed among both those with and without a prior cancer (O/E = 2.7, p = 0.02 and O/E = 1.5, p = 0.06, respectively). Radiation for the prior cancer was not associated with increased occurrence. Military exposure is crudely approximated by examining birth cohorts. However, the cohort data do not support a hypothesis of military exposure.     

Prevalence-corrected prostate cancer incidence rates and trends.

A correction is made of prostate cancer incidence rates based on data from the Surveillance, Epidemiology, and End Results Program of the United States National Cancer Institute. Unlike conventional incidence rates reported by the Program, corrected rates remove from the population the estimated number already diagnosed with the disease. The corrected rates reflect the average prostate cancer risk for men in the at-risk population. Because of the high incidence of and relatively good survival for prostate cancer, the prevalence of this disease is high. Corrected prostate cancer incidence rates were higher in magnitude, particularly in older age groups and among Black men. For example, in 1997 for Whites, the corrected rates were 3.8 percent higher in cases aged 60-69 years, 9.3 percent higher in cases aged 70-79, and 13.1 percent higher in cases aged 80 or more. Corresponding percentages for Blacks were 5.9, 18.9, and 16.9 percent, respectively. Percent changes over calendar time were very similar between corrected and uncorrected prostate cancer incidence rates according to age and race (White and Black). Failure to account for high levels of prostate cancer prevalence in conventional incidence rates of the disease results in underestimation of the rates but little temporal difference in the trends.     

Sunlight and breast cancer incidence in the USSR

Epidemiological and laboratory evidence suggest that vitamin D may play a role in reducing risk of breast cancer. Lack of exposure to ultraviolet sunlight can increase the prevalence of vitamin D deficiency, and may place some populations at higher risk of breast cancer. The association between total average annual sunlight energy striking the ground and age-adjusted breast cancer incidence rates in the USSR was evaluated. Breast cancer had a threefold range of incidence. Sunlight levels varied from 210 to 400 calories per cm2 per day. A statistically significant negative association was found between breast cancer incidence rates and total sunlight levels (R = -0.75, p = 0.001). The slope of the regression line corresponded to two additional cases per 100,000 per year for each reduction of 35 calories per cm2 of sunlight. The pattern of increased breast cancer incidence in regions of low solar radiation in the USSR is consistent with the geographical pattern seen for breast cancer mortality in the US and worldwide. A positive relationship between socioeconomic status and breast cancer incidence was also present in the Soviet Union, based on an approximate socioeconomic measure, the number of doctors per 1000 population (R = +0.89, p = 0.0001). The possibility that correlates of socioeconomic status, such as dietary, ethnic, or behavioural factors, could account for the association is discussed.     

Time trends in cancer incidence in Navarra and Zaragoza, spain

BACKGROUND AND OBJECTIVES: The knowledge of time-related changes occurring in cancer incidence and mortality is an essential element for cancer control. This paper aims to describe the time trends of the more important cancer sites in Navarra and Zaragoza. METHODS: The influence of age, diagnosis period and birth cohort on the observed time trend cancer incidence in Navarre and Zaragoza was assessed using a log-linear model. Results are showed graphically, for the different tumour sites by sex and each registry. RESULTS: Among males, a considerable rise in the incidence of lung cancer (5% per year), prostate cancer (> 2% per year) and non-Hodgkin's lymphomas was found. Among females, the highest increases corresponded to non-Hodgkin's lymphomas, with a yearly rise greater than 7%, and ovarian cancer (4% per year). Breast cancer in women increased in both registries (3.5% per year in Navarre and 0.9% per year in Zaragoza), part of the increment in Navarra being explained by a higher case detection rate. Finally, the incidence of colorectal, bladder and kidney cancer rose more than a 3% per year in both registries and sexes. For most types of tumours, cancer risk increased with subsequent generations. CONCLUSION: The substantial cancer increment observed points out the inefficacy of primary prevention policies, the importance of studying cancer incidence for long time periods and the need to increase the population coverage of Spanish cancer registries.     

Environmental tobacco smoke and breast cancer incidence

To evaluate whether environmental tobacco smoke (ETS) influences breast cancer incidence, data from a population-based case-control study were analyzed. Respondents with available ETS information assessed by in-person questionnaires included 1356 newly diagnosed cases and 1383 controls. Relative to nonsmokers who reported no residential ETS exposure throughout the life course, the odds ratios (OR) for breast cancer were not substantially elevated in relation to ETS exposure, active smoking, or a joint measure of active and passive smoking (OR, 1.15, 95% CI, 0.90, 1.48). An increased OR, however, was noted among nonsmokers who lived with a smoking spouse for over 27 years (2.10, 95% CI, 1.47, 3.02), although no dose-response was evident. Also, among women with hormone-receptor-positive tumors only, the OR for both active and passive smoking was increased (1.42 for ER+ PR+, 95% CI, 1.00, 2.00). Our data suggest that if there is an effect for ETS on breast cancer, that effect is restricted to selected subgroups of women, such as those with long-term exposure from a smoking spouse.     

Alcoholic beverage consumption and breast cancer incidence

Recent case-control studies have suggested that alcohol consumption may be associated with breast cancer incidence. This report is a retrospective cohort study of over 95,000 women who were members of the Kaiser Foundation Health Plan of Northern California. The stated alcohol consumption of these women was recorded at a multiphasic screening examination taken from 1964 to 1972 prior to any diagnosis of breast cancer. The incidence of breast cancer in this cohort was greater for women who drank, and among these drinkers, incidence increased in an irregular trend with heavier alcohol consumption. Control for the effects of race, education, smoking, and reproductive variables related to breast cancer all but eliminated the overall increased relative risk of drinkers compared with that of nondrinkers. However, the relatively small group of women who stated that they had three or more alcoholic drinks per day (5.2 per cent of the total) had a significantly elevated relative risk of 1.4 (p = 0.035) compared with nondrinkers, despite control for all available confounding variables. No significant interaction effect of smoking and alcohol was found. Women who had less than three drinks per day had no increased relative risk over nondrinkers. The results of this study might be explained either by an unrecognized carcinogenic effect of alcohol on breast tissue or by the confounding effect of other factors associated with heavy alcohol use.     

Serum fatty acids and breast cancer incidence

Fatty acid composition of the diet may be essential to the development of breast cancer. We studied the ability of several fatty acids of serum total lipids to predict breast cancer incidence in a case-control study nested within a longitudinal population study. The proportions of fatty acids in serum total lipids were determined from stored serum samples collected at baseline for 127 incident breast cancer cases and 242 matched controls. Women with a higher proportion of total polyunsaturated fatty acids (PUFAs) in serum had a reduced risk of breast cancer. The odds ratio (OR) between the highest and lowest tertiles of serum PUFA was 0.31 (95% confidence interval, CI = 0.12-0.77). This association was mainly due to n-6 PUFAs and especially to linoleic acid. The ORs were 0.35 (CI = 0.14-0.84) and 0.29 (CI = 0.12-0.73), respectively. Of the monounsaturated fatty acids (MUFAs), higher trans-11-18:1 levels were related to an increased breast cancer risk (OR = 3.69, CI = 1.35-10.06). The association was stronger in postmenopausal than in premenopausal women. The present study suggests that higher serum proportions of the n-6 PUFA linoleic acid and lower proportions of the MUFA trans-11-18:1 fatty acid predict a reduced incidence of breast cancer.     

上海市区胃癌发病的时间趋势和特点分析

目的分析1973-2004年上海市区胃癌发病的时间趋势，探讨近年来上海市区胃癌发病的新特点。方法全部资料来源于上海市恶性肿瘤登记报告系统。分别按粗率和标准化率逐年统计1973-2004年市区男性和女性户籍居民的胃癌发病率，用对数线性回归法计算其年度变化百分比（APC），对上海市区近32年的胃癌发病趋势进行估计。对已全部计算机化的2002-2004年上海市区胃癌发病资料，从性别、年龄、诊断分期、病理类型、发病部位等角度进行独立或联合分析，以探讨近年来上海市区胃癌发病的新特点。上海市区的人口资料来自上海市公安局。率的标准化采用世界标准人口。构成比的比较采用χ^2检验。统计分析采用SPSS 10．0软件包。结果1973-2004年上海市区男性和女性居民的胃癌标化发病率均呈现显著而持续的下降趋势，其中男性下降了54．4％，女性下降了37．6％。2002-2004年上海市区共登记报告新发胃癌7630例，男性和女性胃癌的标化发病率分别为27．4／10万和14．0／10万。40岁以下人群的胃癌发病率较低，男女性无明显差异。40岁以上人群的胃癌发病率明显上升且男性逐渐高于女性。在诊断分期上，46．1％的病例具有详细的诊断分期记录，其中Ⅳ期胃癌比例最多，Ⅰ期最少。74．1％的病例为病理诊断，71．7％的病例具有详细的病理类型记录，其中腺癌占76．8％，印戒细咆癌占9．4％。男性腺癌和管状腺癌的比例高于女性，而女性印戒细胞癌的比例高于男性。肠型胃癌仍占主导地位且男性多于女性，而女性弥漫型胃癌的比例高于男性。发病部位以胃窦癌最为常见且女性比例高于男性，而贲门癌男性明显高于女性。远端胃癌中女性的比例高于男性，而近端胃癌中男性明显高于女性。结论上海市区胃癌发病率在1973-2004年间呈现显著而持续的下降趋势，且近年来在性别、年龄、诊断分期、病理类型、发病部位等方面表现出一些有意义的发病特点。     

Small-area distribution of multiple sclerosis incidence in western France: in search of environmental triggers

Background

Despite intensive research over several decades, the etiology of multiple sclerosis (MS) remains poorly understood, although environmental factors are supposedly implicated. Our goal was to identify spatial clusters of MS incident cases at the small-area level to provide clues to local environmental risk factors that might cause or trigger the disease.

Methods

A population-based and multi-stage study was performed in the French Brittany region to accurately ascertain the clinical onset of disease during the 2000–2004 period. The municipality of residence at the time of clinical onset was geocoded. To test for the presence of MS incidence clusters and to identify their approximate locations, we used a spatial scan statistic. We adjusted for socioeconomic deprivation, known to be strongly associated with increased MS incident rates, and scanned simultaneously for areas with either high or low rates. Sensitivity analyses (focusing on relapsing-remitting forms and/or places of residence available within the year following clinical onset) were performed.

Results

A total of 848 incident cases of MS were registered in Brittany, corresponding to a crude annual incidence rate of 5.8 per 100,000 inhabitants. The spatial scan statistic did not find a significant cluster of MS incidence in either the primary analysis (p value ≥ 0.56) or in the sensitivity analyses (p value ≥ 0.16).

Conclusion

The findings of this study indicate that MS incidence is not markedly affected across space, suggesting that in the years preceding the first clinical expression of the disease, no environmental trigger is operative at the small-area population level in the French Brittany region.

     

乳腺癌发病趋向及X射线摄影普查的研究

目的：探讨乳腺癌的发病趋向及影像学普查方法,为早期诊断、早期治疗提供依据。方法：通过探讨乳腺癌流行病学特点,明确乳腺癌发病的危险因素,选择合适的乳腺癌普查方法。结果：乳腺癌发病率持续上升并具有明显的年轻化趋势;乳腺癌的发病与遗传因素、生殖因素、激素代用品的应用、不合理的营养、饮食以及接受放射线等危险因素有密切关系。结论：重视乳腺癌早期诊断、早期治疗,乳腺癌的早期预防尤为重要;X射线检查是目前早期发现乳腺癌最有效的方法。     

Testicular cancer in the United States: trends in incidence and mortality

The patterns of incidence and mortality of testicular cancer in the United States indicate substantial differences by age, race, time period, and geographical region. An epidemic increase over time in the risk of testicular cancer is noted for young men aged 15-44, with the most recent birth cohorts showing the greatest rate of increase. Indeed, some of the evidence suggests the possibility of two separate increases, one apparent from at least the late 1930's through the late 1950's and the second appearing in the late 1970's. The incidence data for blacks also show a young adult peak, even though the rates for whites are four to five times higher than for blacks at all ages except early childhood. Mortality rates for older men consistently declined over the 30-year period, while rates for younger men showed a dramatic drop only for the most recent time period. Aetiological factors yet to be determined may be responsible for the increasing incidence of testicular cancer in young adults. Survival factors appear to explain the age-specific differences between the incidence and mortality curves over time.     

High burden of breast cancer in Belgium: recent trends in incidence (1999-2006) and historical trends in mortality (1954-2006)

Introduction  

In Belgium, breast cancer mortality has been monitored since 1954, whereas cancer incidence data have only been made available for a few years. In this article we update historical trends of breast cancer mortality and describe the recent breast cancer incidence.