Age-Related Crossover in Breast Cancer Incidence Rates Between Black and White Ethnic Groups
Age-Related Crossover in Breast Cancer Incidence Rates Between Black and White Ethnic Groups
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DOI：
10.1093/jnci/djn411
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发表时间：
2008-12-17
影响因子：
10.3
通讯作者：
Pfeiffer, Ruth M.
中科院分区：
文献类型：
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作者：
Anderson, William F.;Rosenberg, Philip S.;Pfeiffer, Ruth M.
虽然在40岁以下的妇女中，黑人妇女的乳腺癌发病率高于白色妇女，但在40岁或40岁以上的妇女中，情况正好相反。黑人和白色种族之间发病率的交叉已经得到了很好的描述，还没有完全理解，并被视为人为因素。为了量化这种发病率交叉，我们检查了1975年1月1日至12月31日美国国家癌症研究所监测、流行病学和最终结果数据库中440 653名浸润性乳腺癌妇女的数据。2004.浸润性女性乳腺癌的数据按种族、诊断时的年龄、诊断年份和肿瘤特征分层。标准的描述性分析补充泊松回归模型，年龄-时期-队列模型，和双组分混合模型。所有的统计检验都是双侧的，我们观察到年龄和种族之间的定性（即交叉或反向）相互作用。也就是说，（以每10万妇女年的乳腺癌数量表示）黑人妇女的乳腺癌发病率较高（15.5）比白色妇女（13.1）40岁以下（差异= 2.4，95%置信区间[CI] = 2.4至2.4），然后，年龄特异性比率交叉，白色女性的比率（281.3）高于40岁或以上的黑人女性（239.5）（差异= 41.8，95% CI = 41.7至41.9）。对于评估的所有肿瘤特征，观察到黑人至白色人的发生率交叉，尽管低风险肿瘤特征的交叉发生在诊断年龄早于高风险肿瘤特征。种族组之间的发生率交叉是稳健的（即可靠和可重现）调整年龄-时期-队列模型中的日历周期和出生队列效应（P <0.001的差异种族）。虽然这项生态研究不能确定个人水平的因素，负责种族交叉的生命率，它证实，黑人和白色族裔群体之间乳腺癌发病率与年龄相关的交叉是一种强有力的年龄特异性效应，与时期和群组效应无关。
Although breast cancer incidence is higher in black women than in white women among women younger than 40 years, the reverse is true among those aged 40 years or older. This crossover in incidence rates between black and white ethnic groups has been well described, has not been completely understood, and has been viewed as an artifact.To quantify this incidence rate crossover, we examined data for 440 653 women with invasive breast cancer from the National Cancer Institute's Surveillance, Epidemiology, and End Results database from January 1, 1975, through December 31, 2004. Data on invasive female breast cancers were stratified by race, age at diagnosis, year of diagnosis, and tumor characteristics. Standard descriptive analyses were supplemented with Poisson regression models, age-period-cohort models, and two-component mixture models. All statistical tests were two-sided.We observed qualitative (ie, crossing or reversing) interactions between age and race. That is, age-specific incidence rates overall (expressed as number of breast cancers per 100 000 woman-years) were higher among black women (15.5) than among white women (13.1) younger than 40 years (difference = 2.4, 95% confidence interval [CI] = 2.4 to 2.4), and then, age-specific rates crossed with rates higher among white women (281.3) than among black women (239.5) aged 40 years or older (difference = 41.8, 95% CI = 41.7 to 41.9). The black-to-white incidence rate crossover was observed for all tumor characteristics assessed, although the crossover occurred at earlier ages of diagnosis for low-risk tumor characteristics than for high-risk tumor characteristics. The incidence rate crossover between ethnic groups was robust (ie, reliable and reproducible) to adjustment for calendar period and birth cohort effects in age-period-cohort models (P < .001 for difference by race).Although this ecologic study cannot determine the individual-level factors responsible for the racial crossover in vital rates, it confirms that the age-related crossover in breast cancer incidence rates between black and white ethnic groups is a robust age-specific effect that is independent of period and cohort effects.