Recent trends in U.S. breast cancer incidence, survival, and mortality rates.

BACKGROUND Clinical trials have demonstrated that use of mammographic screening and advances in therapy can improve prognosis for women with breast cancer. PURPOSE We determined the trends in breast cancer mortality rates, as well as incidence and survival rates by extent of disease at diagnosis, for white women in the United States and considered whether these trends are consistent with widespread use of such beneficial medical interventions. METHODS We examined mortality data from the National Center for Health Statistics and incidence and survival data by extent of disease from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, all stratified by patient age, using statistical-regression techniques to determine changes in the slope of trends over time. RESULTS The age-adjusted breast cancer mortality rate for U.S. white females dropped 6.8% from 1989 through 1993. A significant decrease in the slope of the mortality trend of approximately 2% per year was observed in every decade of age from 40 to 79 years of age. Trends in incidence rates were also similar among these age groups: localized disease rates increased rapidly from 1982 through 1987 and stabilized or increased more slowly thereafter; regional disease rates decreased after 1987; and distant disease rates have remained level over the past 20 years. Three-year relative survival rates increased steadily and significantly for both localized and regional disease from 1980 through 1989 in all ages, with no evidence of an increase in slope in the late 1980s. IMPLICATIONS The decrease in the diagnosis of regional disease in the late 1980s in women over the age of 40 years likely reflects the increased use of mammography earlier in the 1980s. The increase in survival rates, particularly for regional disease, likely reflects improvements in systemic adjuvant therapy. Statistical modeling indicates that the recent drop in breast cancer mortality is too rapid to be explained only by the increased use of mammography; likewise, there has been no equivalent dramatic increase in survival rates that would implicate therapy alone. Thus, indications are that both are involved in the recent rapid decline in breast cancer mortality rates in the United States.

[1]  M. Brown,et al.  Is the supply of mammography machines outstripping need and demand? An economic analysis. , 1990, Annals of internal medicine.

[2]  L. Tabár,et al.  REDUCTION IN MORTALITY FROM BREAST CANCER AFTER MASS SCREENING WITH MAMMOGRAPHY Randomised Trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare , 1985, The Lancet.

[3]  N. Wald,et al.  Report of the European Society for Mastology Breast Cancer Screening Evaluation Committee (1993) , 1993 .

[4]  G. Bonadonna,et al.  Combination chemotherapy as an adjuvant treatment in operable breast cancer. , 1976, The New England journal of medicine.

[5]  Anthony Howell,et al.  Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy. 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Early Breast Cancer Trialists' Collaborative Group. , 1992 .

[6]  Mammography guidelines 1983: Background statement and update of cancer‐related checkup guidelines for breast cancer detection in asymptomatic women age 40 to 49 , 1983, CA: a cancer journal for clinicians.

[7]  K Smigel,et al.  Breast cancer death rates decline for white women. , 1995, Journal of the National Cancer Institute.

[8]  R. Tarone,et al.  Implications of birth cohort patterns in interpreting trends in breast cancer rates. , 1992, Journal of the National Cancer Institute.

[9]  P. Remington,et al.  Mammography screening and increased incidence of breast cancer in Wisconsin. , 1991, Journal of the National Cancer Institute.

[10]  M Quinn,et al.  Changes in incidence of and mortality from breast cancer in England and Wales since introduction of screening , 1995, BMJ.

[11]  C. Percy,et al.  Surveillance, epidemiology, and end results : incidence and mortality data, 1973-1977 , 1981 .

[12]  B A Miller,et al.  Recent incidence trends for breast cancer in women and the relevanceof early detection: An update , 1993, CA: a cancer journal for clinicians.

[13]  V. Barnett,et al.  Applied Linear Statistical Models , 1975 .

[14]  E. Feuer,et al.  A method for partitioning cancer mortality trends by factors associated with diagnosis: an application to female breast cancer. , 1994, Journal of clinical epidemiology.

[15]  L Kessler,et al.  Changes in the use of screening mammography: evidence from the 1987 and 1990 National Health Interview Surveys. , 1994, American journal of public health.

[16]  Max H. Myers,et al.  Manual for Staging of Cancer , 1992 .

[17]  J. Fraumeni,et al.  Declining breast cancer mortality among young American women. , 1987, Journal of the National Cancer Institute.

[18]  M. Gail,et al.  A model for projecting cancer incidence and mortality in the presence of prevention, screening, and treatment programs , 1986 .

[19]  K. Clinton.  Mortality rates by stage-at-diagnosis. , 1994, Seminars in surgical oncology.

[20]  Diane Soloman,et al.  The 1988 Bethesda system for reporting cervical/vaginal cytologic diagnoses: Developed and approved at the national cancer institute workshop in Bethesda, MD, December 12–13, 1988 , 1989, Diagnostic cytopathology.

[21]  C. Redmond,et al.  Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. , 1995, New England Journal of Medicine.

[22]  J. Glick.  Meeting highlights: adjuvant therapy for breast cancer. , 1988, Journal of the National Cancer Institute.

[23]  M. Baum,et al.  CONTROLLED TRIAL OF TAMOXIFEN AS ADJUVANT AGENT IN MANAGEMENT OF EARLY BREAST CANCER Interim Analysis at Four Years by Nolvadex Adjuvant Trial Organisation , 1983, The Lancet.

[24]  W D Flanders,et al.  Does increased detection account for the rising incidence of breast cancer? , 1991, American journal of public health.

[25]  N. Wald,et al.  Report of the European Society of Mastology Breast Cancer Screening Evaluation Committee * , 1993, Tumori.

[26]  Karla Kerlikowske,et al.  Benefit of mammography screening in women ages 40–49 years: Current evidence from randomized controlled trials , 1995, Cancer.

[27]  Young Jl,et al.  SEER Program: cancer incidence and mortality in the United States 1973-81. , 1984 .

[28]  E White,et al.  Evaluation of the increase in breast cancer incidence in relation to mammography use. , 1990, Journal of the National Cancer Institute.

[29]  G. Dodd,et al.  The American Cancer Society guidelines for the cancer‐related checkup: An update , 1991, CA: a cancer journal for clinicians.

[30]  Jan Howard,et al.  Using mammography for cancer control: An unrealized potential , 1987, CA: a cancer journal for clinicians.

[31]  B. Hankey,et al.  Breast cancer among black and white women in the 1980s. Changing patterns in the United States by race, age, and extent of disease , 1993, Cancer.

[32]  V. Beral,et al.  Sudden fall in breast cancer death rates in England and Wales , 1995, The Lancet.

[33]  F. Ederer,et al.  The relative survival rate: a statistical methodology. , 1961, National Cancer Institute monograph.

[34]  Eric J. Feuer,et al.  How much of the recent rise in breast cancer incidence can be explained by increases in mammography utilization? A dynamic population model approach. , 1992, American journal of epidemiology.