Distinct incidence patterns among in situ and invasive breast carcinomas, with possible etiologic implications
Distinct incidence patterns among in situ and invasive breast carcinomas, with possible etiologic implications
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DOI：
10.1007/s10549-004-1483-9
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发表时间：
2004-11-01
影响因子：
3.8
通讯作者：
Devesa, SS
中科院分区：
文献类型：
--
作者：
Anderson, WF;Chu, KC;Devesa, SS
背景浸润性乳腺癌（InvBC）的发病模式和雌激素受体（ER）表达定义的InvBC的发病模式已得到很好的确立，但乳腺原位癌（CIS）的发病模式尚未得到很好的定义。因此，我们在SEER项目中检查并比较了CIS和InvBC的发病模式，以确定这些模式并产生病因学假设。数据按年龄分层< 50 and >= 50岁，以接近绝经期。在1973-2000年期间，CIS的年年龄调整发病率上升了660%，InvBC上升了36%，其中年龄≥ 50岁的妇女增长最快。CIS的乳腺特异性发病率曲线在50岁之前增加，然后变平，与ER表达无关。另一方面，整体InvBC和ER阳性表达定义的InvBC的发生率随着年龄的增长而持续增加，而ER阴性表达定义的InvBC的发生率在50年后趋于平稳。CIS和ER阴性InvBC的年龄频率分布表现为双峰人群，主要早发性发病高峰在50岁。ER阳性InvBC的年龄分布呈双峰型，以71岁晚发型为主。在过去的三十年中，美国CIS和InvBC的年龄调整发病率趋势不同，可能是由于筛查乳腺X线检查和/或病因多样性。事实上，特定年龄的发病率模式表明，致癌事件在生殖生命早期运作有更大的影响CIS和InvBC定义的ER阴性表达比InvBC整体和InvBC定义的ER阳性表达。
Background. Incidence patterns are well-established for invasive breast carcinoma (InvBC) overall and for InvBC defined by estrogen receptor (ER) expression, but are not as well-defined for breast carcinoma in situ (CIS).Methods. We, therefore, examined and compared the incidence patterns for CIS and InvBC in the SEER program to define these patterns and to generate etiologic hypotheses. Data were stratified by age < 50 and >= 50 years to approximate menopause.Results. During the years 1973-2000, annual age-adjusted incidence rates rose 660% for CIS and 36% for InvBC, with the most rapid increases occurring in women age >= 50 years. Age-specific incidence rate curves for CIS increased until age 50 years, and then flattened, irrespective of ER expression. On the other hand, rates for InvBC overall and for InvBC defined by ER-positive expression increased continuously with aging, whereas rates for InvBC defined by ER-negative expression flattened after 50 years. Age frequency distribution for CIS and for ER-negative InvBC demonstrated bimodal populations, with a predominant early onset peak incidence at age 50 years. Age frequency distribution for ER-positive InvBC showed bimodal populations with a predominant late-onset mode at age 71 years.Conclusion. Over the last three decades, age-adjusted incidence trends differed for CIS and InvBC in the United States, possibly due to screening mammography and/or etiologic diversity. Indeed, age-specific incidence patterns suggested that carcinogenic events operating early in reproductive life had greater impact upon CIS and InvBC defined by ER-negative expression than upon InvBC overall and InvBC defined by ER-positive expression.