Breast cancer incidence trends by race/ethnicity

1. Breast cancer incidence trends by race/ethnicity Lihua Liu, PhD Juanjuan Zhang, MS Dennis Deapen, DrPH Los Angeles Cancer Surveillance Program University of Southern California

2. Los Angeles County, California • Total 9.8 million residents: • 2.8 million non-Hispanic white • 2.1 million Hispanic white • 0.9 million black • 1.3 million Asian • 0.4 million Chinese • 0.3 million Filipino • 0.1 million Japanese • 0.2 million Korean • 36% foreign born • 74% entered after 1980 Source: 2006-2008 American Community Survey 3-year estimates

3. Background

6. The Importance of Deapen et al, IJC 2002, 99:747-750 • Generated intense public interest • Received lots of media attention • Raised awareness on heterogeneity among Asian-Americans • Alerted physicians and general public about breast cancer in Asian-Americans • Underlined the importance of disaggregating the Asians by ethnicity

7. The Challenge of Surveillance by Asian Ethnicity • Numerators • Accurate identification • Denominators • Lack of official annual estimates • CSP population estimates • With Asian ethnic details

8. The Question What would the breast cancer incidence trends look like after 1997?

9. Quiz Q: What happened in recent years that may have affected breast cancer incidence trends? A: The 2002 report from the Women’s Health Initiative (WHI) Trial - Combined hormone therapy in postmenopausal women was stopped

10. After the 2002 WHI report Clarke CA, Glaser SL, Uratsu CS, Selby JV, Kushi LH, Herrinton LJ . Recent declines in hormone therapy utilization and breast cancer incidence: clinical and population-based evidence. J ClinOncol. 2006;24(33);e49-50.  

11. MMWR. June 8, 2007 / 56(22);549-553

12. Materials & Methods • Invasive breast cancer, women, 1972-2007 • Total 160,935 cases • 111,314 NH White • 16,562 Black • 23,111 Hispanic • 2,572 Chinese • 3,801 Filipino • 2,492 Japanese • 1,083 Korean • AAIR, ASIR (2000 US Standard), APC by race/ethnicity & time period

13. Trends of annual age-adjusted (2000 US Standard) incidence rates of invasive breast cancer among women by race/ethnicity, Los Angeles County, CA, 1972-2007

14. Annual percent change (APC) in age-adjusted (2000 US Standard) incidence rates of invasive breast cancer by time period and race/ethnicity, LA Co.

15. Age-specific incidence rates of invasive breast cancer among women by race/ethnicity and time period, Los Angeles County

16. Trends of age-specific incidence rates of invasive breast cancer among women by race/ethnicity, LA Co.

17. Trends of age-specific incidence rates of invasive breast cancer among women by race/ethnicity, LA Co.

18. Conclusions • Recent declines in breast cancer incidence are limited to certain age/ethnic groups • Breast cancer remains to be a serious threat to women, especially Asian-Americans • Lifestyle/environmental factors are important in the development of breast cancer • Study of breast cancer among immigrants may help identify risk factors and protective lifestyle factors in breast cancer development