Hyuna Sung1, Philip S Rosenberg2, Wan-Qing Chen2, Mikael Hartman2, Wei-Yen Lim2, Kee Seng Chia2, Oscar Wai-Kong Mang2, Chun-Ju Chiang2, Daehee Kang2, Roger Kai-Cheong Ngan2, Lap Ah Tse2, William F Anderson2, Xiaohong R Yang2. 1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (HS, PSR, WFA, XRY); National Office for Cancer Prevention and Control & National Central Cancer Registry, National Cancer Center, Beijing, China (WQC); Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden (MH); Saw Swee Hock School of Public Health, National University of Singapore, Singapore (MH, WYL, KSC); Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (MH); Hong Kong Cancer Registry, Hospital Authority, Hong Kong, China (OWKM, RKCN); Taiwan Cancer Registry and Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (CJC); Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea (DK); Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China (RKCN); Division of Occupational and Environmental Health, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China (LAT). hyuna.sung@nih.gov. 2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (HS, PSR, WFA, XRY); National Office for Cancer Prevention and Control & National Central Cancer Registry, National Cancer Center, Beijing, China (WQC); Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden (MH); Saw Swee Hock School of Public Health, National University of Singapore, Singapore (MH, WYL, KSC); Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (MH); Hong Kong Cancer Registry, Hospital Authority, Hong Kong, China (OWKM, RKCN); Taiwan Cancer Registry and Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (CJC); Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea (DK); Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China (RKCN); Division of Occupational and Environmental Health, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China (LAT).
Abstract
BACKGROUND: Previous reports suggested that female breast cancer is associated with earlier ages at onset among Asian than Western populations. However, most studies utilized cross-sectional analyses that may be confounded by calendar-period and/or birth cohort effects. We, therefore, considered a longitudinal (forward-looking) approach adjusted for calendar-period changes and conditioned upon birth cohort. METHODS: Invasive female breast cancer data (1988-2009) were obtained from cancer registries in China, Hong Kong, South Korea, Taiwan, Singapore, and the United States. Age-period-cohort models were used to extrapolate longitudinal age-specific incidence rates for the 1920, 1944, and 1970 birth cohorts. RESULTS: Cross-sectional age-specific incidence rates rose continuously until age 80 years among US white women, but plateaued or decreased after age 50 years among Asian women. In contrast, longitudinal age-specific rates were proportional (similar) among all Asian countries and the United States with incidence rates rising continuously until age 80 years. The extrapolated estimates for the most recent cohorts in some Asian countries actually showed later ages at onset than in the United States. Additionally, over successive birth cohorts, the incidence rate ratios (IRRs) for the longitudinal curves converged (narrowed) between Asian and US white women. CONCLUSIONS: Similar longitudinal age-specific incidence rates along with converging IRRs indicate that the age effects for invasive breast cancer are more similar among Asian and Western populations than might be expected from a solely cross-sectional analysis. Indeed, the Asian breast cancer rates in recent generations are even surpassing the historically high rates in the United States, highlighting an urgent need for efficient prevention and treatment strategies among Asian populations. Published by Oxford University Press 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
BACKGROUND: Previous reports suggested that female breast cancer is associated with earlier ages at onset among Asian than Western populations. However, most studies utilized cross-sectional analyses that may be confounded by calendar-period and/or birth cohort effects. We, therefore, considered a longitudinal (forward-looking) approach adjusted for calendar-period changes and conditioned upon birth cohort. METHODS: Invasive female breast cancer data (1988-2009) were obtained from cancer registries in China, Hong Kong, South Korea, Taiwan, Singapore, and the United States. Age-period-cohort models were used to extrapolate longitudinal age-specific incidence rates for the 1920, 1944, and 1970 birth cohorts. RESULTS: Cross-sectional age-specific incidence rates rose continuously until age 80 years among US white women, but plateaued or decreased after age 50 years among Asian women. In contrast, longitudinal age-specific rates were proportional (similar) among all Asian countries and the United States with incidence rates rising continuously until age 80 years. The extrapolated estimates for the most recent cohorts in some Asian countries actually showed later ages at onset than in the United States. Additionally, over successive birth cohorts, the incidence rate ratios (IRRs) for the longitudinal curves converged (narrowed) between Asian and US white women. CONCLUSIONS: Similar longitudinal age-specific incidence rates along with converging IRRs indicate that the age effects for invasive breast cancer are more similar among Asian and Western populations than might be expected from a solely cross-sectional analysis. Indeed, the Asian breast cancer rates in recent generations are even surpassing the historically high rates in the United States, highlighting an urgent need for efficient prevention and treatment strategies among Asian populations. Published by Oxford University Press 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
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