Journal of the National Cancer Institute Advance Access originally published online on August 14, 2007
JNCI Journal of the National Cancer Institute 2007 99(17):1335-1339; doi:10.1093/jnci/djm111
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© The Author 2007. Published by Oxford University Press.
Declines in Invasive Breast Cancer and Use of Postmenopausal Hormone Therapy in a Screening Mammography Population
For the National Cancer Institute–Sponsored Breast Cancer Surveillance Consortium
Affiliations of authors: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA (KK); General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Group Health Center for Health Studies, Seattle, WA (DLM, DSMB, RW); Department of Biostatistics, University of Washington, Seattle, WA (DLM, RW); Departments of Family Medicine and Public Health & Preventive Medicine, Oregon Health and Science University, Portland, OR (PAC)
Correspondence to: Karla Kerlikowske, MD, General Internal Medicine Section, San Francisco Veterans Affairs Medical Center, 111A1, 4150 Clement Street, San Francisco, CA 94121 (e-mail: Karla.Kerlikowske{at}ucsf.edu).
Whether a recent large decline in use of postmenopausal hormone therapy after the release of the Women's Health Initiative findings in July 2002 and/or a decline in screening mammography use is related to a recently reported decline in breast cancer incidence in the United States is controversial. We prospectively collected data from four screening mammography registries from January 1997 through December 2003 for 603411 screening mammography examinations performed on women aged 50–69 years. Of these women, 3238 were diagnosed with breast cancer within 12 months of a screening examination. We calculated quarterly rates of self-reported current postmenopausal hormone therapy use and of invasive breast cancer, ductal carcinoma in situ (DCIS), and estrogen receptor (ER)–positive invasive breast cancer adjusted for age, registry, and time between screening examinations. All statistical tests were two-sided. Between 2000 and 2002 and between 2002 and 2003, annual rates of postmenopausal hormone therapy use declined by 7% and 34%, respectively (Ptrend<.001 for both). Between 2000 and 2003, annual rates of invasive cancer declined by 5% (Ptrend =.003). Between 2001 and 2003, annual rates of ER-positive invasive breast cancer declined by 13% (Ptrend=.002). Rates of DCIS were stable during the study period. Our finding of a statistically significant decline in the rate of ER-positive invasive breast cancer in a screening mammography population after the start of a concomitant substantial decline in postmenopausal hormone therapy use suggests that a decline in screening mammography rates is unlikely to account for the recent decline in US breast cancer incidence.
| Context and Caveats Prior knowledge The incidence of breast cancer in the United States has dropped in the last few years, but whether the drop is related to a decline in the use of hormone therapy or to a decline in screening mammography has not been clear. Study design Data were collected prospectively from four registries on more than 600 000 screening mammography examinations conducted from 1997 through 2003 on women aged 50–69 years. Trends in annual rates of breast cancer and postmenopausal hormone therapy use, calculated quarterly, were compared. Contribution Between 2000 and 2003, annual rates of postmenopausal hormone therapy use declined, as did annual rates of invasive breast cancer. Between 2001 and 2003, annual rates of estrogen receptor–positive invasive breast cancer also declined. Implications The observation of a decline in the rate of estrogen receptor–positive breast cancer in a population of women receiving screening mammography suggests that the recent decline in breast cancer incidence in the United States is unlikely to be due to a decline in screening mammography rates. The decline in use of postmenopausal hormone therapy use is a more likely contributor to the breast cancer decline. Limitations Statistical constraints imposed on the analysis of temporal changes could have caused errors in trend tests. Breast cancer rates were not determined separately among never and former users of hormone therapy.
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Manuscript received April 4, 2007; revised June 25, 2007; accepted June 27, 2007.
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