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Breast Cancer Rates
In the United States, death rates for breast cancer have been stable for the past 50
years, even as incidence rates have increased (71). Before 1980
white women had slightly higher age-adjusted death rates than black women, but since then
death rates for black women have increased 16 percent, surpassing rates for white women,
which decreased 5 percent over the same period (53). Breast cancer
incidence and death rates increase with age, but the rate of increase slows after
menopause (81). Among premenopausal women, breast cancer incidence
is higher in blacks (81).
Two well-established risk factors for breast cancer are personal history of breast,
endometrial, or ovarian cancer and family history of breast cancer (82).
The recent identification of genetic mutations linked to early onset breast cancer may
explain at least part of this familial aggregation (73). Older age,
higher socioeconomic status, and never having been married have been associated with
increased risk of breast cancer (82). Other established risk
factors include exposure to high doses of ionizing radiation; certain breast tissue
abnormalities; and factors related to reproductive history such as early onset of first
menarche, late onset of menopause, late age of first full term pregnancy or nulliparity (83). The effects of alcohol consumption, oral contraceptive use,
postmenopausal estrogen therapy, diet, and pesticide exposure are still being considered (82-84). As many as 70 percent of women diagnosed with breast cancer may
not have any identifiable risk factor (83).
Between 1950 and 1980, the highest breast cancer death rates for white and black women
were found in the urban areas of the New England and Middle Atlantic regions, although the
north-south differences diminished over this period (8, 9). High
rates for postmenopausal white females were concentrated in the urban areas of these
northeastern States, but much of this excess can be explained by regional differences of
recognized risk factors (85); premenopausal rates varied little by
region (8). A comparison of the age-specific and age-adjusted maps for 1988-92 shows that
the higher age-adjusted rates in the northeast are still predominantly due to geographic
differences among older white women. The map for younger ages shows an east-to-west
decline in rates, but the range of rates is very narrow. High rates among black females
appear to be scattered across the southern States for both age groups.
References:
(8) Pickle, L. W., Mason, T. J., Howard, N., et al. Atlas of U. S. Cancer Mortality
Among Whites: 1950-1980. Washington: USGPO (DHHS) Pub. No. (NIH) 87-2900). 1987.
(9)Pickle, L. W., Mason, T. J., Howard, N., et al. Atlas of U. S. Cancer Mortality Among
NonWhites: 1950-1980. Washington: USGPO (DHHS) Pub. No. (NIH) 90-1582). 1990.
(53) National Center for Health Statistics. Health, United States, 1994. Hyattsville,
Maryland: Public Health Service. 1995.
(71) American Cancer Society, Inc. Cancer Facts and Figures 1994. Atlanta: American Cancer
Society, 1994.
(73) Olopade, O.I. , Cummings, S. Genetic Counseling for Cancer: Part 1: Principles and
PRactice of Oncology Updates 10 (1): 1-13. 1996.
(81) Velentgas, P., Daling, J.R. Risk Factors for Breast Cancer in Younger Women. Monogr.
National Cancer Institute 16: 15-22. 1994.
(82) Nichols, D. H., The Epidemiologic Characteristics of Breast Cancer. Clin. Obstet.
Gynecol. 37(4): 925-30. 1994.
(83) Harris, J. R., Morrow, M. Bonadonna, G., Chapter 40: "Cancer of the
Breast". In: Devita, V.T., Jr., Hellman, S., Rosenberg, S.A., eds. Cancer: Principles
and Practice of Oncology. Philadelphia: J. B. Lippincott Company. 1264-1332. 1993.
(84) Kelsey, J. L. Breast Cancer Epidemiology: Summary and Future Directions. Epi. Review
15 (1): 256-63. 1993.
(85) Sturgeon, S. R., Schairer, C., Gail, M., et al. Geographic Variation in Mortality
from Breast Cancer
Atlas of United States Mortality by L.W. Pickle, M. Mungiole, G.K.
Jones, and A.A. White, US DHHS, Centers for Disease Control and Prevention, National
Center for Health Statistics: Hyattsville, Maryland, Dec. 1996, DHHS Publication No. (PHS)
97-1015.
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