Changing trends. An overview of breast cancer incidence and mortality.

The incidence of breast cancer rose about 1% per year between 1940 and 1980 according to data in the Connecticut Tumor Registry. A sharp increase of 32% was reported between 1980 and 1987 in the Surveillance, Epidemiology and End Results Program of the National Cancer Institute. Data from this program shows that the increase in incidence was due to localized cases and cancers of less than 2 cm in greatest dimension. In addition, a sharp increase in carcinoma in situ was observed. The increase in breast cancer incidence coincides with an increased use of mammography in asymptomatic women in the 1980s. Mortality from breast cancer has changed little since the 1930s, but the increases in localized and small-size tumors and decreases in the rate of tumors of 3 cm or larger at diagnosis indicates that breast cancer mortality may start to decrease. Evidence from provisional breast cancer monthly mortality data suggests that there was a 3-6% drop in 1991 compared to 1990.

The lifetime risk of developing breast cancer.

BACKGROUND: The lifetime risk of developing breast cancer in U.S. women, often quoted as one in nine, is a commonly cited cancer statistic. However, many estimates have used cancer rates derived from total rather than the cancer-free population and have not properly accounted for multiple cancers in the same individual. PURPOSE: Our purpose was to provide a revised method for calculating estimates of the lifetime risk of developing breast cancer and to aid in interpretation of the estimates. METHODS: A multiple decrement life table was derived by applying age-specific incidence and mortality rates from cross-sectional data to a hypothetical cohort of women. Incidence, mortality, and population data from 1975-1988 were used, representing the geographic areas of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. The incidence rates reflected only the first breast primary cancer; mortality rates reflected causes other than breast cancer. The population denominator used in calculating incidence rates was adjusted to reflect only those women without previously diagnosed breast cancers in the hypothetical cohort. RESULTS: Our calculations showed an overall lifetime risk for developing invasive breast cancer of approximately one in eight with use of 1987-1988 SEER data, although up to age 85, it was still the commonly quoted one in nine. CONCLUSION: Our estimate was calculated assuming constant age-specific rates derived from 1987-1988 SEER data. Because incidence and mortality rates change over time, conditional risk estimates over the short term (10 or 20 years) may be more reliable. A large portion of the rise in the lifetime risk of breast cancer estimated using 1975-1977 data (one in 10.6) to an estimate using 1987-1988 data (one in eight) may be attributed to 1) early detection of prevalent cases due to increased use of mammographic screening and 2) lower mortality due to causes other than breast cancer. A common misperception is that the lifetime risk estimate assumes that all women live to a particular age (e.g., 85 or 95). In fact, the calculation assumes that women can die from causes other than breast cancer at any possible age. Cutting off the lifetime risk calculation at age 85 assumes that no women develop breast cancer after that age. While the lifetime risk of developing breast cancer rose over the period 1976-1977 to 1987-1988, the lifetime risk of dying of breast cancer increased from one in 30 to one in 28, reflecting generally flat mortality trends.

Cancer statistics for African Americans.

Although cancer remains a major public health burden for African Americans, progress is being achieved. Since 1984, the cancer mortality rate has declined two percent. Stomach and uterine cancer death rates have shown dramatic decreases in the last 30 years. Tobacco use is declining among blacks and is much lower among black adolescents than among their white counterparts. Black women are getting Pap smears more frequently than are any other ethnic group. Evidence is now accumulating that the causes of increased cancer morbidity and mortality in African Americans are related more to poverty and lack of education and access to care than to any inherent racial characteristics. Such observations support a range of opportunities whereby the impact of cancer in African Americans can be diminished through community programs and public health action.

Sterilization regret among Puerto Rican women.

This study examined sterilization regret among Puerto Rican women with contraceptive tubal sterilizations (TS) using retrospective data from a population-based survey of women aged 15 to 49 years. Twenty-one percent of the 846 respondents expressed some regret, with 11% stating definite dissatisfaction with the decision. Factors associated with regret were young age at TS, absence of daughters, someone else making the decision to be sterilized, medical indications for TS, sterilization failure, and living with a new marital partner. There were no significant effects associated with the timing of sterilization, whether interval or postpartum, or with the type of last delivery. Other factors not independently associated with regret included years since TS, parity, education, and age at follow-up.

PIP: Reasons for sterilization regret in Puerto Rican women were examined from interview data from the 1982 Puerto Rico Fertility and Family Planning Assessment. 846 of the 3175 women surveyed had contraceptive tubal sterilization, i.e., medical sterilizations, vasectomies and hysterectomies were excluded. Sterilization took place between 1954 and 1982, in women aged 15-49 years old at the time of the interviews. 42% of the subjects lived in rural areas. Regret was expressed on the questionnaire as definitely yes, maybe yes, maybe no, or definitely no. 21% of these women expressed some regret, and 11% felt definite regret for having been sterilized. The most common reasons for regret were desire for more children then, or change of heart later, and not being consulted about the operation. Factors associated with regret were age under 25 at operation, having no daughters, husband or physician having decided on sterilization, medical indications for sterilization, sterilization failure and living with a new partner. Factors not significantly related to regret included timing of sterilization with respect to childbirth, years since sterilization, parity, education and age at survey.

A case-control study of breast cancer stratified by estrogen receptor status.

A population-based case-control study was conducted to examine whether tumor estrogen receptor status differentiated risk factor patterns for breast cancer. From December 1980 to December 1982, 458 women with newly diagnosed breast cancer and 568 control women, aged 20-54 years, from the Atlanta, Georgia, metropolitan area were interviewed. On the basis of tumor estrogen receptor results, cases were classified as receptor-positive or receptor-negative. Intercase analysis showed that age was positively and significantly associated with estrogen receptor-positive breast cancer (p = 0.001); the relative risk for an estrogen receptor-positive as opposed to an estrogen receptor-negative tumor was elevated threefold among women aged 50-54 years compared with those aged less than 35 years. In the case-control analysis, race was the only individual factor that demonstrated a significant difference in the risk for estrogen receptor-positive versus estrogen receptor-negative cancer (p less than 0.05), with blacks being at a 25% excess risk for estrogen receptor-negative cancer compared with whites. Although a history of benign breast disease was a risk factor for both positive and negative tumors, the association was stronger for the estrogen receptor-positive tumors. Postmenopausal women were at a lower risk for both cancer subtypes compared with premenopausal women. Compared with non-users, women who had ever taken oral contraceptives had a 16% decrease in the risk for receptor-positive cancer and a 22% increase in the risk for receptor-negative cancer. These results are consistent with the notion that certain exposure variables may relate to hormonal status, possibly by augmentation or suppression of estrogen receptor activity.

Increase in high-grade lymphomas in young men.

The relative frequencies of non-Hodgkin's lymphoma (NHL) subtypes and primary sites of presentation in young men before and during the acquired immunodeficiency syndrome epidemic were studied. Diagnostic pathological specimens were reviewed and classified according to the Working Formulation grades for cases of NHL in men aged 20-49 years identified through a population-based cancer registry. 76% of the lymphomas diagnosed in 1981-82 were intermediate or high grade, compared with 29% of those diagnosed in 1976-77. This increase was still significant when men aged 20-39 years and 40-49 years were grouped separately, and for married men. The proportion of extranodal lymphomas diagnosed in men aged 20-39 years also rose significantly from the early to the later period.

Patient attitudes toward physician consent in epidemiologic research.

Attitudes of patients toward the necessity of physician consent in epidemiologic studies were assessed. Questionnaires were mailed to women with breast, endometrial and ovarian cancers who had previously participated in a personal interview study (N = 692). Of respondents (N = 514), only 2 per cent would have preferred their physician to have withheld approval, and half considered physician permission necessary. Thirty-five per cent reported that their doctor talked to them about the study prior to the interview. Implications of including physician consent in study protocols are discussed.

KIE: The initiation of contact with a patient for an epidemiologic study is usually contingent upon the prior consent of the attending physician. To assess the attitudes of patients toward the necessity of physician consent, questionnaires were mailed to 692 women with breast, endometrial, or ovarian cancers who had previously participated in a personal interview study. Only 2% of the 514 respondents would have preferred that their physicians withhold approval; half considered physician permission necessary. One-third of the patients--most frequently black women and women of lower educational levels--reported that their doctors had talked to them about the study prior to the interview.