Registre des cancers de Loire-Atlantique et de Vendée, 50 route de Saint-Sébastien, Nantes Cedex 1, France.
Cancer Epidemiol. 2010 Jun;34(3):238-43. doi: 10.1016/j.canep.2010.03.007. Epub 2010 Apr 20.
A recent decline in breast cancer incidence rates has been reported in the United States and in Europe. This decrease has been partly attributed to the reduced use of hormone replacement therapy (HRT). No study in Europe has detailed recent breast cancer incidence trends both by hormonal receptor status and mode of detection at an individual level.
We examined trends in breast cancer incidence rates in the French administrative area of Loire-Atlantique between 1991 and 2007, by age, mode of detection, histological subtype, estrogen/progesterone receptor (ER/PR) status and grade. Annual age-standardized breast cancer incidence rates were estimated using the Loire-Atlantique and Vendée Cancer Registry data. Annual percentage changes (APCs) were estimated using an age-adjusted Poisson regression model.
Incidence rates of breast cancer increased 3.5% per year in 1991-2003, dropped -4.3% per year in 2003-2006 and increased in 2007 (9.1%). Stratified analyses by age groups showed that the decrease concerned predominantly women aged 50-64 years, whereas an increasing proportion of cancers detected by organized screening was observed in this age group. Among these women, the decline of incidence particularly concerned positive estrogen and progesterone receptor tumors, lobular subtype tumors, and low-grade tumors.
The drop in breast cancer incidence rates observed between 2003 and 2006 in women 50-64 years old was greater for ER+PR+ tumors. During the same period, the incidence of breast cancers diagnosed by organized screening increased. These patterns appear consistent with an impact of the reduced use of HRT.
美国和欧洲近期报道乳腺癌发病率有所下降。这种下降部分归因于激素替代疗法（HRT）的使用减少。在欧洲，尚无研究详细描述在个体水平上按激素受体状态和检测方式划分的最近乳腺癌发病趋势。
我们研究了 1991 年至 2007 年期间法国卢瓦尔河地区乳腺癌发病率的变化趋势，分析了年龄、检测方式、组织学亚型、雌激素/孕激素受体（ER/PR）状态和分级等因素。使用卢瓦尔河地区和旺代癌症登记处的数据估计了每年的年龄标准化乳腺癌发病率。使用年龄调整泊松回归模型估计了年百分比变化（APC）。
1991 年至 2003 年期间，乳腺癌发病率每年增加 3.5%，2003 年至 2006 年期间每年下降 4.3%，2007 年又有所增加（9.1%）。按年龄组分层分析表明，这种下降主要涉及 50-64 岁的女性，而在该年龄组中，通过有组织筛查检测到的癌症比例有所增加。在这些女性中，发病率的下降特别涉及到雌激素和孕激素受体阳性肿瘤、小叶肿瘤和低级别肿瘤。
在 50-64 岁的女性中，2003 年至 2006 年间乳腺癌发病率的下降对于 ER+PR+肿瘤更为明显。在此期间，通过有组织筛查诊断出的乳腺癌发病率增加。这些模式似乎表明 HRT 使用减少产生了影响。
