Originally published as JCO Early Release 10.1200/JCO.2007.11.6079 on August 6 2007

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Anderson, W. F. Articles by Pfeiffer, R. M. Search for Related Content PubMed PubMed Citation Articles by Anderson, W. F. Articles by Pfeiffer, R. M. Social Bookmarking                            What's this?

Shifting Breast Cancer Trends in the United States

William F. Anderson, Anne S. Reiner, Rayna K. Matsuno, Ruth M. Pfeiffer

From the Biostatistics Branch, Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD

Address reprint requests to William F. Anderson, MD, MPH, Biostatistics Branch, Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, EPS, Room 8036, 6120 Executive Blvd, Bethesda, MD 20892-7244; e-mail: wanderso{at}mail.nih.gov

Purpose United States breast cancer incidence rates declined during the years 1999 to 2003, and then reached a plateau. These recent trends are impressive and may indicate an end to decades of increasing incidence.

Methods To put emerging incidence trends into a broader context, we examined age incidence patterns (frequency and rates) during five decades. We used age density plots, two-component mixture models, and age-period-cohort (APC) models to analyze changes in the United States breast cancer population over time.

Results The National Cancer Institute's Connecticut Historical Database and Surveillance, Epidemiology, and End Results program collected 600,000+ in situ and invasive female breast cancers during the years 1950 to 2003. Before widespread screening mammography in the early 1980s, breast cancer age-at-onset distributions were bimodal, with dominant peak frequency (or mode) near age 50 years and smaller mode near age 70 years. With widespread screening mammography, bimodal age distributions shifted to predominant older ages at diagnosis. From 2000 to 2003, the bimodal age distribution returned to dominant younger ages at onset, similar to patterns before mammography screening. APC models confirmed statistically significant calendar-period (screening) effects before and after 1983 to 1987.

Conclusion Breast cancer in the general United States population has a bimodal age at onset distribution, with modal ages near 50 and 70 years. Amid a background of previously increasing and recently decreasing incidence rates, breast cancer populations shifted from younger to older ages at diagnosis, and then back again. These dynamic fluctuations between early-onset and late-onset breast cancer types probably reflect a complex interaction between age-related biologic, risk factor, and screening phenomena.

published online ahead of print at www.jco.org on July 30, 2007.

Supported in part by the Intramural Research Program of the National Institutes of Health/National Cancer Institute.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				W. F. Anderson, I. Jatoi, and M. E. Sherman Qualitative Age Interactions in Breast Cancer Studies: Mind the Gap J. Clin. Oncol., November 10, 2009; 27(32): 5308 - 5311. [Full Text] [PDF]

				W. F. Anderson, P. S. Rosenberg, I. Menashe, A. Mitani, and R. M. Pfeiffer Age-Related Crossover in Breast Cancer Incidence Rates Between Black and White Ethnic Groups J Natl Cancer Inst, December 17, 2008; 100(24): 1804 - 1814. [Abstract] [Full Text] [PDF]

				L. A. Brinton, M. E. Sherman, J. D. Carreon, and W. F. Anderson Recent Trends in Breast Cancer Among Younger Women in the United States J Natl Cancer Inst, November 19, 2008; 100(22): 1643 - 1648. [Abstract] [Full Text] [PDF]

				A. N.A. Tosteson, N. K. Stout, D. G. Fryback, S. Acharyya, B. A. Herman, L. G. Hannah, E. D. Pisano, and for the DMIST Investigators Cost-Effectiveness of Digital Mammography Breast Cancer Screening Ann Intern Med, January 1, 2008; 148(1): 1 - 10. [Abstract] [Full Text] [PDF]