Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State

Abstract

Background: The American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), and North American Association of Central Cancer Registries (NAACCR) collaborate annually to produce updated, national cancer statistics. This Annual Report includes a focus on breast cancer incidence by subtype using new, national-level data.

Methods: Population-based cancer trends and breast cancer incidence by molecular subtype were calculated. Breast cancer subtypes were classified using tumor biomarkers for hormone receptor (HR) and human growth factor-neu receptor (HER2) expression.

Results: Overall cancer incidence decreased for men by 1.8% annually from 2007 to 2011 [corrected]. Rates for women were stable from 1998 to 2011. Within these trends there was racial/ethnic variation, and some sites have increasing rates. Among children, incidence rates continued to increase by 0.8% per year over the past decade while, like adults, mortality declined. HR+/HER2- breast cancers, the subtype with the best prognosis, were the most common for all races/ethnicities with highest rates among non-Hispanic white women, local stage cases, and low poverty areas (92.7, 63.51, and 98.69 per 100000 non-Hispanic white women, respectively). HR+/HER2- breast cancer incidence rates were strongly, positively correlated with mammography use, particularly for non-Hispanic white women (Pearson 0.57, two-sided P < .001). Triple-negative breast cancers, the subtype with the worst prognosis, were highest among non-Hispanic black women (27.2 per 100000 non-Hispanic black women), which is reflected in high rates in southeastern states.

Conclusions: Progress continues in reducing the burden of cancer in the United States. There are unique racial/ethnic-specific incidence patterns for breast cancer subtypes; likely because of both biologic and social risk factors, including variation in mammography use. Breast cancer subtype analysis confirms the capacity of cancer registries to adjust national collection standards to produce clinically relevant data based on evolving medical knowledge.

Figure 1.

Original vs imputed age-specific rates by subtype, unknown subtype for diagnosis year 2011, and areas in the United States with high-quality incidence data*^. A) Hormone receptor (HR)+/ human epidermal growth factor receptor 2 (HER2)- rates per 100000 women^Ŧ. B) Triple-negative rates per 100000 women. C) HR+HER2+ rates per 100000 women. D) HR-/HER2+ rates per 100000 women. *Population-based registries meeting North American Association of Central Cancer Registries quality criteria and high completeness of HR/HER2 data include: Alaska, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawai’i, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming. ^All 10 imputations had near identical rate estimates. ^ŦNote: HR+/HER2- has much higher rates, so this figure has a different y-axis. The unknown rate is a reference rate from the original data and is the same for each figure. HER2 = human epidermal growth factor receptor 2; HR = hormone receptor.

Figure 2.

Age-specific incidence rates of invasive breast cancer by subtype, by race/ethnicity, for diagnosis year 2011, and areas in the United States with high-quality incidence data*. A) Age-specific rates for non-Hispanic white women. B) Age-specific rates for non-Hispanic black women. C) Age-specific rates for non-Hispanic Asian/Pacific Islander women. D) Age-specific rates for Hispanic women. *Population-based registries meeting North American Association of Central Cancer Registries quality criteria and high completeness of hormone receptor/ human epidermal growth factor receptor 2 data include: Alaska, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawai’i, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming. HER2 = human epidermal growth factor receptor 2; HR = hormone receptor.

Figure 3.

Age-adjusted incidence rates of invasive breast cancer by subtype, stage, race/ethnicity for diagnosis year 2011, and areas in the United States with high-quality incidence data*. A) HR+/HER2- rates per 100000 women ^Ŧ. B) Triple-negative rates per 100000 women. C) HR+HER2+ rates per 100000 women. D) Hormone receptor (HR)-/ human epidermal growth factor receptor 2 (HER2)+ rates per 100000 women. Error bars represent 95% confidence intervals. *Population-based registries meeting North American Association of Central Cancer Registries quality criteria and high completeness of HR/HER2 data include: Alaska, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawai’i, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming. API = Asian/Pacific Islander; HER2 = human epidermal growth factor receptor 2; HR = hormone receptor; NH=Non-Hispanic.

Figure 4.

Age-adjusted incidence rates of invasive breast cancer by subtype, grade, race/ethnicity for diagnosis year 2011, and areas in the United States with high-quality incidence data*. A) Hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)- rates per 100000 women ^Ŧ. B) Triple-negative rates per 100000 women. C) HR+HER2+ rates per 100000 women. D) HR-/HER2+ rates per 100000 women. Error bars represent 95% confidence intervals. *Population-based registries meeting North American Association of Central Cancer Registries quality criteria and high completeness of HR/HER2 data include: Alaska, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawai’i, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming. API = Asian/Pacific Islander; HER2 = human epidermal growth factor receptor 2; HR = hormone receptor; NH=Non-Hispanic.

Figure 5.

Age-adjusted incidence rates of invasive breast cancer by subtype, census tract poverty, race/ethnicity for diagnosis year 2011, and areas in the United States with high-quality incidence data reporting census tract-based poverty measure*. A) Hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)- rates per 100000 women ^Ŧ. B) Triple-negative rates per 100000 women. C) HR+HER2+ rates per 100000 women. D) HR-/HER2+ rates per 100000 women. Error bars represent 95% confidence intervals. *Database with census tract-level poverty is a subset of the high quality registries who report tract-level poverty category: Alaska, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawai’i, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maryland, Detroit, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Washington, West Virginia, Wisconsin, Wyoming. API = Asian/Pacific Islander; HER2 = human epidermal growth factor receptor 2; HR = hormone receptor; NH=Non-Hispanic.

Figure 6.

Age-specific incidence rates of invasive breast cancer by subtype for diagnosis year 2011 for states with high-quality incidence data. A) Hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)- state rates per 100000 women ^Ŧ. B) Triple-negative state rates per 100000 women. C) HR+HER2+ state rates per 100000 women. D) HR-/HER2+ state rates per 100000 women. Bars indicate 95% confidence interval; gray shading denotes tertiles (white indicates no data available). API = Asian/Pacific Islander; HER2 = human epidermal growth factor receptor 2; HR = hormone receptor; NH=Non-Hispanic.