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. 2015 Jun 10;107(9):djv159.
doi: 10.1093/jnci/djv159. Print 2015 Sep.

Estrogen Receptor Status and the Future Burden of Invasive and In Situ Breast Cancers in the United States

Philip S Rosenberg  1 , Kimberly A Barker  2 , William F Anderson  2
Affiliations

Estrogen Receptor Status and the Future Burden of Invasive and In Situ Breast Cancers in the United States

Philip S Rosenberg et al. J Natl Cancer Inst. .

Abstract

Background: No study has predicted the future incidence rate and annual burden (number) of new cases in the United States of invasive and in situ female breast cancers stratified by the estrogen receptor (ER) status.

Methods: We constructed forecasts for women age 30 to 84 years in 2011 through 2030 using cancer incidence data from the Surveillance, Epidemiology, and End Results Program, novel age-period-cohort forecasting models, and population projections from the US Census Bureau.

Results: The total number of new tumors (invasive plus in situ) is expected to rise from 283 000 in 2011 to 441 000 in 2030 (plausible range 353 500 to 466 700 cases). The proportion of all new case patients age 70 to 84 years is expected to increase from 24.3% to 34.8%, while the proportion ages 50 to 69 years is expected to decrease from 54.7% to 43.6%. The proportion of ER-positive invasive cancers is expected to remain nearly the same at 62.6%, whereas the proportion of ER-positive in situ cancers is expected to increase from 19.1% to 28.9%. The proportion of ER-negative cancers (invasive and in situ) is expected to decrease from 16.8% to 8.6%.

Conclusions: Breast cancer overall will rise in the United States through 2030, especially for ER-positive in situ tumors among women age 70 to 84 years. In contrast, ER-negative invasive and in situ tumors will fall, for reasons that are not fully understood. These results highlight a need to optimize case management among older women, characterize the natural history of in situ cancers, and identify those factors responsible for declining ER-negative incidence.

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Figures

Figure 1.
Figure 1.
Observed and projected incidence of invasive and in situ estrogen receptor (ER)–positive breast tumors in Surveillance, Epidemiology, and End Results (SEER) 13 and corresponding forecasts of cancer burden in the entire United States. A) Observed and projected incidence of invasive ER+ tumors per 100 000 woman-years in SEER 13. B) Predicted burden of invasive ER+ tumors in the United States (number of newly diagnosed cases per year) by age group and overall. C) Observed and projected incidence of in situ ER+ tumors per 100 000 woman-years in SEER 13. D) Predicted burden of in situ ER+ tumors in the entire United States. In each panel, circles show point estimates for each year. Shaded bands show point-wise 95% confidence limits. Vertical reference line separates observed from forecast period. ER = estrogen receptor.
Figure 2.
Figure 2.
Observed and projected incidence of invasive and in situ estrogen receptor–negative breast tumors in SEER 13 and corresponding forecasts of cancer burden in the entire United States. See legend to Figure 1 for details. ER = estrogen receptor.
Figure 3.
Figure 3.
Absolute number of newly diagnosed invasive and in situ estrogen receptor (ER)–positive (ER+) and ER-negative (ER-) breast cancers in the United States by single year of age, 2011 and 2030. In each panel, 2011 forecast is shown in red and 2030 in blue; error bars for 2011 and shaded bands for 2030 show point-wise 95% confidence limits. A) ER+ invasive, (B) ER+ in situ, (C) ER- invasive, (D) ER- in situ. ER = estrogen receptor.
Figure 4.
Figure 4.
Distribution of breast cancer burden in the United States by age group and tumor type, 2011 and 2030. Panels show pie charts sized in proportion to the total number of new case patients per year. Slices show percentage distribution. A) Case patients in 2011 by age group. B) Case patients in 2030 by age group. C) Cases in 2011 by tumor type. D) Case patients in 2030 by tumor type. ER = estrogen receptor.
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