Recinda L Sherman, MPH, PhD, CTR Program Manager, Data Use & Research North American Association of Central Cancer Registries
(217) 698-0800 x 6; [email protected]
On behalf of NAACCR and my co-authors from ACS, CDC, and NCI, I am pleased to present the latest Annual Report to the Nation on the Status of Cancer. This is our 17th Annual Report, and NAACCR was the lead agency. The Annual Report represents a collaborative effort by senior researchers from each major cancer surveillance organization in the United States to produce the up to date and comprehensive trends in cancer incidence and mortality.
Each year we also focus on a special topic, and this year our topic is breast cancer subtypes. For the first time on a national level, we have published newly available data on breast cancer incidence rates by demographic and tumor characteristics for the four intrinsic molecular subtypes (HR+/HER-, triple negative, HR+/HER+, and HR-/HER+). We present rates for each subtype stratified by race/ethnicity and by age, stage, grade, and census tract-based poverty. We also present rates by subtype by state.
Presenting cancer statistics by molecular or histological subtypes is becoming progressively important as critical clinical treatment decisions are based on subtype for an increasing number of cancers. As medical knowledge advances, the future of cancer registries lies in our ability to accommodate this advancement. Diagnosis year 2010 marks the first year of nationally required Her2 receptor status reporting. And this year’s special topic represents another success story for cancer registries and standard setters in reaching a balance among the competing demands of maintaining a reasonable burden on the registration system, preserving clarity and consistency of coding, and meeting the needs for clinical and public health research and prevention.
Please don’t hesitate to contact me with any questions about the Annual Report.
Abstract
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Background: The American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), and North American Association of Central Cancer Registries (NAACCR) collaborate annually to produce updated, national cancer statistics. This Annual Report includes a focus on breast cancer incidence by subtype using new,national-level data.
Methods: Population-based cancer trends and breast cancer incidence by molecular subtype were calculated. Breast cancer subtypes were classified using tumor biomarkers for hormone receptor (HR) and human growth factor-neu receptor (HER2) expression.
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Results: Overall cancer incidence decreased for men by 1.8% annually from 2007 to 2011. Rates for women were stable from 1998 to 2011. Within these trends there was racial/ethnic variation, and some sites have increasing rates. Among children, incidence rates continued to increase by 0.8% per year over the past decade while, like adults, mortality declined. Overall mortality has been declining for both men and women since the early 1990’s and for children since the 1970’s. HR+/HER2- breast cancers, the subtype with the best prognosis, were the most common for all races/ethnicities with highest rates among non-Hispanic white women, local stage cases, and low poverty areas (92.7, 63.51, and 98.69 per 100 000 non-Hispanic white women, respectively). HR+/HER2- breast cancer incidence rates were strongly, positively correlated with mammography use, particularly for non-Hispanic white women (Pearson 0.57, two-sided P < .001). Triple-negative breast cancers, the subtype with the worst prognosis, were highest among non-Hispanic black women (27.2 per 100 000 non-Hispanic black women), which is reflected in high rates in southeastern states.
Conclusions: Progress continues in reducing the burden of cancer in the United States. There are unique racial/ethnicspecific incidence patterns for breast cancer subtypes; likely because of both biologic and social risk factors, including variation in mammography use. Breast cancer subtype analysis confirms the capacity of cancer registries to adjust national collection standards to produce clinically relevant data based on evolving medical knowledge.
