Racial and regional disparities of triple negative breast cancer incidence rates in the United States: An analysis of 2011-2019 NPCR and SEER incidence data

Abstract

Objective: Triple negative breast cancer (TNBC) is a more aggressive subtype resistant to conventional treatments with a poorer prognosis. This study was to update the status of TNBC and the temporal changes of its incidence rate in the US.

Methods: Women diagnosed with breast cancer during 2011-2019 were obtained from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology and End Results (SEER) Program SEER^*Stat Database which covers the entire population of the US. The TNBC incidence and its temporal trends by race, age, region (state) and disease stage were determined during the period.

Results: A total of 238,848 (or 8.8%) TNBC women were diagnosed during the study period. TNBC occurred disproportionally higher in women of Non-Hispanic Black, younger ages, with cancer at a distant stage or poorly/undifferentiated. The age adjusted incidence rate (AAIR) for TNBC in all races decreased from 14.8 per 100,000 in 2011 to 14.0 in 2019 (annual percentage change (APC) = -0.6, P = 0.024). Incidence rates of TNBC significantly decreased with APCs of -0.8 in Non-Hispanic White women, -1.3 in West and -0.7 in Northeastern regions. Women with TNBC at the age of 35-49, 50-59, and 60-69 years, and the disease at the regional stage displayed significantly decreased trends. Among state levels, Mississippi (20.6) and Louisiana (18.9) had the highest, while Utah (9.1) and Montana (9.6) had the lowest AAIRs in 2019. New Hampshire and Indiana had significant and highest decreases, while Louisiana and Arkansas had significant and largest increases in AAIR. In individual races, TNBC displayed disparities in temporal trends among age groups, regions and disease stages. Surprisingly, Non-Hispanic White and Hispanic TNBC women (0-34 years), and Non-Hispanic Black women (≥70 years) during the entire period, as well as Asian or Pacific Islander women in the South region had increased trends between 2011 and 2017.

Conclusion: Our study demonstrates an overall decreased trend of TNBC incidence in the past decade. Its incidence displayed disparities among races, age groups, regions and disease stages. Special attention is needed for a heavy burden in Non-Hispanic Black and increased trends in certain groups.

Keywords: HER2; SEER; estrogen receptor; incidence; progesterone receptor; racial disparity; temporal trend; triple negative breast cancer.

Figure 1

Temporal changes in overall age adjusted incidence rates of TNBC, non-TNBC and all breast cancer during 2011–2019. (A) TNBC displayed a decreased trend of annual age adjusted incidence rates (AAIRs). (B) Non-TNBC, but not all breast cancer, showed an increased trend of AAIRs. Solid trend lines indicate a significant change in APC, whereas dashed lines show a non-significant change.

Figure 2

Temporal changes in age adjusted incidence rates of TNBC by race, age group, region and disease stage during 2011–2019. (A) Age group. (B) Race. (C) Region. (D) Disease stage. Solid lines indicate a significant annual percentage change (APC) of age adjusted incidence rate. Dashed lines show no significant change.

Figure 3

Age adjusted incidence rates (AAIR) of TNBC in individual states during 2011–2019. (A) AAIR of TNBC in 2019. (B) Percentage of change in AAIR in individual states from 2011 to 2019. Please note that there is no incidence rate of TNBC of NV in 2018 and 2019. The incidence rate of NV in 2017 is shown on the map.

Figure 4

Temporal changes in age adjusted incidence rates of TNBC by age group in individual races during 2011–2019. (A) NHW. (B) NHB. (C) Hispanic. (D) API. Solid lines indicate significant change in annual percentage change (APC) of age adjusted incidence rate. Dashed lines show no significant change.

Figure 5

Temporal changes in age adjusted incidence rates of TNBC by region in individual races during 2011–2019. (A) NHW. (B) NHB. (C) Hispanic. (D) API. Solid trend lines indicate a significant annual percentage change (APC) of age adjusted incidence rate. Dashed lines show no significant change.

Figure 6

Temporal changes in age adjusted incidence rate of TNBC by disease stage in individual races during 2011–2019. (A) Non-Hispanic White (NHW). (B) Non-Hispanic Black (NHB). (C) Hispanic. (D) Asian or Pacific Islander (API). Solid lines indicate significant change in annual percentage change (APC) of age adjusted incidence rates. Dashed lines show no significant change.