Decreasing Incidence of Estrogen Receptor-Negative Breast Cancer in the United States: Trends by Race and Region

Abstract

Background: Incidence of estrogen receptor (ER)-negative breast cancer, an aggressive subtype, is highest in US African American women and in Southern residents but has decreased overall since 1992. We assessed whether ER-negative breast cancer is decreasing in all age groups and cancer registries among non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic White (HW) women.

Methods: We analyzed 17 Surveillance, Epidemiology, and End-Results (SEER) Program registries (12 for 1992-2016; 5 for 2000-2016) to assess NHW, NHB, and HW trends by ER status and age group (30-39 years, 40-49 years, 50-69 years, 70-84 years). We used hierarchical age-period-cohort models that account for sparse data, which improve estimates to quantify between-registry heterogeneity in mean incidence rates and age-adjusted trends vs SEER overall.

Results: Overall, ER-negative incidence was highest in NHB, then NHW and HW women, and decreased from 1992-2016 in each age group and racial or ethnic group. The greatest decrease was for HW women aged 40-49 years, with an annual percent change of -3.5%/y (95% credible interval = -4.4%, -2.7%) averaged over registries. The trend heterogeneity was statistically significant in every race or ethnic and age group. Furthermore, the incidence relative risks by race or ethnicity compared with the race-specific SEER average were also statistically significantly heterogeneous across the majority of registries and age groups (62 of 68 strata). The greatest heterogeneity was seen in HW women, followed by NHB women, and the least in NHW women.

Conclusions: Decreasing ER-negative breast cancer incidence differs meaningfully by US region and age among NHB and HW women. Analytical studies including minority women from higher and lower incidence areas may provide insights into breast cancer racial disparities.

Figure 1.

Fitted incidence rates of estrogen receptor-negative breast cancer among non-Hispanic Black (triangles), non-Hispanic White (squares), and Hispanic White (circles) women by age group (30-39 years, 40-49 years, 50-69 years, and 70-84 years) for all Surveillance, Epidemiology, and End Results Program registries combined (1992-2016). Posterior medians with 95% credible intervals are shown.

Figure 2.

Risk of estrogen receptor-negative breast cancer incidence by age group (30-39 years, 40-49 years, 50-69 years, and 70-84 years), race or ethnicity, and Surveillance, Epidemiology, and End Results Program (SEER) registry. For each panel, estimates are shown relative to the “typical” (median) SEER registry—within race or ethnicity and age group. Posterior medians with 95% credible intervals are shown. GA = Georgia; SF = San Francisco; SJ = San Jose.

Figure 3.

Net drifts (model-based estimates of annual percent change in age-adjusted rates) for estrogen receptor-negative breast cancer incidence by age group (30-39 years, 40-49 years, 50-69 years, and 70-84 years), race or ethnicity, and Surveillance, Epidemiology, and End Results Program registry. Posterior medians with 95% credible intervals are shown. GA = Georgia; SF = San Francisco; SJ = San Jose.