Seattle Children's Hospital and University of Washington, MB 8501, PO Box 5371, Seattle, WA 98105-0371, USA.
JAMA. 2013 Feb 27;309(8):800-5. doi: 10.1001/jama.2013.776.
Evidence from the US National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database suggests that the incidence of advanced breast cancer in young women is increasing.
To quantify this trend and analyze it as a function of stage at diagnosis, race/ethnicity, residence, and hormone receptor status.
DESIGN, SETTING, AND PATIENTS: Breast cancer incidence, incidence trends, and survival rates as a function of age and extent of disease at diagnosis were obtained from 3 SEER registries that provide data spanning 1973-2009, 1992-2009, and 2000-2009. SEER defines localized as disease confined to the breast, regional to contiguous and adjacent organ spread (eg, lymph nodes, chest wall), and distant disease to remote metastases (bone, brain, lung, etc).
Breast cancer incidence trends in the United States.
In the United States, the incidence of breast cancer with distant involvement at diagnosis increased in 25- to 39-year-old women from 1.53 (95% CI, 1.01 to 2.21) per 100,000 in 1976 to 2.90 (95% CI, 2.31 to 3.59) per 100,000 in 2009. This is an absolute difference of 1.37 per 100,000, representing an average compounded increase of 2.07% per year (95% CI, 1.57% to 2.58%; P < .001) over the 34-year interval. No other age group or extent-of-disease subgroup of the same age range had a similar increase. For 25- to 39-year-olds, there was an increased incidence in distant disease among all races and ethnicities evaluated, especially non-Hispanic white and African American, and this occurred in both metropolitan and nonmetropolitan areas. Incidence for women with estrogen receptor-positive subtypes increased more than for women with estrogen receptor-negative subtypes.
Based on SEER data, there was a small but statistically significant increase in the incidence of breast cancer with distant involvement in the United States between 1976 and 2009 for women aged 25 to 39 years, without a corresponding increase in older women.
美国国家癌症研究所的监测、流行病学和最终结果（SEER）数据库中的证据表明，年轻女性中晚期乳腺癌的发病率正在上升。
定量分析这一趋势，并按诊断时的分期、种族/族裔、居住地和激素受体状态进行分析。
设计、环境和患者：从提供 1973-2009 年、1992-2009 年和 2000-2009 年数据的三个 SEER 登记处获得了乳腺癌发病率、发病率趋势以及与年龄和诊断时疾病程度相关的生存率。SEER 将局限性疾病定义为仅局限于乳房的疾病，区域性疾病定义为相邻和邻近器官扩散（例如，淋巴结、胸壁），而远处疾病则定义为远处转移（骨、脑、肺等）。
美国乳腺癌发病率趋势。
在美国，25-39 岁女性诊断时远处转移乳腺癌的发病率从 1976 年的每 10 万人 1.53（95%CI，1.01 至 2.21）增加到 2009 年的每 10 万人 2.90（95%CI，2.31 至 3.59）。这是每 10 万人中 1.37 的绝对差异，代表在 34 年期间平均每年复合增长率为 2.07%（95%CI，1.57%至 2.58%；P<.001）。在同一年龄范围内的其他任何年龄组或疾病范围亚组均未出现类似的增长。对于 25-39 岁的女性，在评估的所有种族和族裔中，远处疾病的发病率都有所增加，尤其是非西班牙裔白人和非裔美国人，而且这种情况不仅出现在大都市地区，也出现在非大都市地区。雌激素受体阳性亚型的女性发病率增长高于雌激素受体阴性亚型的女性。
基于 SEER 数据，在 1976 年至 2009 年间，美国 25-39 岁女性的远处转移性乳腺癌发病率略有上升，但年龄较大的女性没有相应增加，这一趋势具有统计学意义。
