RESEARCH ARTICLE br Breast Cancer Incidence by Stage
Breast Cancer Incidence by Stage Before and After
Change in Screening Guidelines
Introduction: The U.S. Preventive Services Task Force changed breast cancer screening guidelines in November 2009 for mammograms in women aged 40−49 and 50−74 years. The aim of this study was to assess the impact of the 2009 guideline changes on breast cancer incidence by stage among women aged 40−49 and 50−74 years in the U.S.
Methods: This was a cross-sectional trend analysis of the impact of 2009 guideline change on breast cancer incidence by stage, using data from the National Program for Cancer Registries and Surveillance, Epidemiology, and End Results Incidence−U.S. Cancer Statistics 2001−2014 database among women aged 40−74 years. Incidence was age adjusted to the U.S. standard population. Data were collected in 2001−2014, released in 2017, and analyzed in 2018.
Results: Among women aged 40−49 years, the 4-year average annual incidence of breast cancer increased slightly in 2011−2014 for in situ, localized, and distant cancer, but decreased for regional cancer compared with the incidence in 2006−2009. Among women aged 50−74 years, the 4-year average annual incidence of breast cancer increased in 2011−2014 for localized and distant cancer, but decreased for in situ and regional cancer. Joinpoint analyses revealed that annual percentage changes decreased after 2009 for distant cancer among both women aged 40−49 and 50−74 years. The composition of breast cancer by stage was similar between 2006−2009 and 2011−2014 among both women aged 40−49 and 50−74 years.
Conclusions: Changes in breast cancer screening by the 2009 U.S. Preventive Services Task Force guidelines had little immediate adverse effects on the stage distribution of breast cancer diagnoses in the U.S. Monitoring the incidence by cancer stages over time is needed.
INTRODUCTION B reast cancer is the second most prevalent cancer after SCH-772984 cancers and is the second leading cause of cancer death after lung cancer among women
in the U.S.1,2 Life time risk for developing invasive breast cancer among women in the U.S. is 12.3%.1 The Ameri-can Cancer Society estimates that in 2017 among women in the U.S., there will be 252,710 new cases of invasive breast cancer, 63,410 new cases of in situ breast cancer, and 40,610 breast cancer deaths.3 Moreover, racial/eth-nic disparities exist for cancer incidence and cause-spe-cific survival: non-Hispanic blacks have the highest proportions of and lowest survival rates from regional (35%) and distant (8%) stage disease.4−7 However, breast cancer mortality can be reduced by early detection of the
tumor using mammogram screening.8,9 In November 2009, the U.S. Preventive Services Task Force (USPSTF) changed breast cancer screening guidelines for mammo-grams from every 1−2 years in women 40 years or older
From the 1Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas; 2Center for Interdisciplinary Research in Women’s Health, University of Texas Medical Branch, Galveston, Texas; 3Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas; and 4Institute for Translational Science, University of Texas Medi-cal Branch, Galveston, Texas
Address correspondence to: Fangjian Guo, MD, PhD, Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women’s Health, University of Texas Medical Branch, 301 University Blvd., Galveston TX 77555. E-mail: [email protected]
to biennial (i.e., every other year) mammograms in women aged 50−74 years and personalized screening decisions for women aged 40−49 years.10 This screening guideline change is highly controversial. Although it has been reported that annual mammogram rates signifi-cantly decreased after the guideline change,11−14 others found minimal or no changes in screening rates.15−17 Collaborative models of breast cancer screening strate-gies suggested that a reduction in screening frequency would result in less benefit (mortality reduction) but also fewer false-positive results in the biennial mammog-
raphy as compared with the annual mammography in women aged 50 to 74 years.18−20 It is still unclear whether this increased interval for mammography screening as per the 2009 USPSTF guidelines will lead to increased detection of invasive breast cancer, or changes in the composition of breast cancer by stage. This study aims to assess whether there were differences in breast cancer incidence by stage before and after the 2009 guideline changes among women in the U.S. aged 40−49 and 50−74 years.