Breast cancer incidence, 1980-2006: Combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status
Breast cancer incidence, 1980-2006: Combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status
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DOI：
10.1093/jnci/djm059
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发表时间：
2007-08-01
影响因子：
10.3
通讯作者：
Hoover, Robert N.
中科院分区：
文献类型：
--
作者：
Glass, Andrew G.;Lacey, James V., Jr.;Hoover, Robert N.
背景乳腺癌发病率至少自1935-1939年以来一直在上升，但最近的美国数据显示，2003年乳腺癌发病率在统计上显著下降，并持续到2004年。确定造成这一长期增长和近期发病率下降的潜在原因的具体原因一直具有挑战性。自1980年以来，乳房X光检查的比率和更年期激素治疗的使用发生了显著的变化，这进一步增加了复杂性。方法使用美国大型预付费医疗计划Kaiser Permanente Northwest的肿瘤登记、临床、病理和药房数据，通过筛查乳房X光检查和分发绝经激素治疗处方，比较1980至2006年间特定年龄和调整年龄的乳腺癌发病率(2年移动平均值)。结果1980-2006年间，计划成员共确诊浸润性乳腺癌7386例。从20世纪80年代初(105.6)到1992年至1993年(131.7)，每100000名妇女经年龄调整的乳腺癌总发病率上升了25%，2000年至2001年(151.3)又增加了15%，到2003年至2004年(123.6)下降了18%，2005年至2006年(126.2)略有上升。这些模式主要限于45岁或45岁以上的女性和雌激素受体阳性(ER+)乳腺癌。ER阴性肿瘤的发病率没有经历ER+肿瘤的上升，但从2003年到2006年也急剧下降。乳房X光筛查率从1980年到1993年大幅上升，但后来趋于平稳，从1993年到2006年，75%-79%的45岁或45岁以上的妇女至少每两年接受一次乳房X光检查。绝经期激素治疗剂量，特别是雌激素+孕激素制剂，从1988年到2002年有所增加，但在2002年后下降了约75%。结论从1980年到2006年，乳腺癌发病率，特别是ER+肿瘤的数量和质量趋势，乳房X光检查的模式和绝经激素治疗的使用发生了重大变化。
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 100000 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-plusprogestin 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.