J Natl Cancer Inst. 2019 Dec 1;111(12):1298-1306. doi: 10.1093/jnci/djz090.
BACKGROUND: The incidence of breast cancer among younger East Asian women has been increasing rapidly over recent decades. This international collaborative study systemically compared the differences in age-specific incidences and pathological characteristics of breast cancer in East Asian women and women of predominantly European ancestry. METHODS: We excerpted analytic data from six national cancer registries (979 675 cases) and eight hospitals (18 008 cases) in East Asian countries and/or regions and, for comparisons, from the US Surveillance, Epidemiology, and End Results program database. Linear regression analyses of age-specific incidences of female breast cancer and logistic regression analyses of age-specific pathological characteristics of breast cancer were performed. All statistical tests were two-sided. RESULTS: Unlike female colorectal cancer, the age-specific incidences of breast cancer among East Asian women aged 59 years and younger increased disproportionally over recent decades relative to rates in US contemporaries. For years 2010-2014, the estimated age-specific probability of estrogen receptor positivity increased with age in American patients, whereas that of triple-negative breast cancer (TNBC) declined with age. No similar trends were evident in East Asian patients; their probability of estrogen receptor positivity at age 40-49 years was statistically significantly higher (odd ratio [OR] = 1.50, 95% confidence interval [CI] = 1.36 to 1.67, P < .001) and of TNBC was statistically significantly lower (OR = 0.79, 95% CI = 0.71 to 0.88, P < .001), whereas the probability of ER positivity at age 50-59 years was statistically significantly lower (OR = 0.88, 95% CI = 0.828 to 0.95, P < .001). Subgroup analyses of US Surveillance, Epidemiology, and End Results data showed similarly distinct patterns between East Asian American and white American patients. CONCLUSIONS: Contrasting age-specific incidences and pathological characteristics of breast cancer between East Asian and American women, as well as between East Asian Americans and white Americans, suggests racial differences in the biology.
背景：近几十年来，东亚年轻女性乳腺癌的发病率一直在迅速上升。本项国际合作研究系统地比较了东亚女性与主要为欧洲血统女性乳腺癌在年龄特异性发病率和病理特征方面的差异。
方法：我们从东亚国家和/或地区的 6 个国家癌症登记处（979675 例）和 8 家医院（18008 例）中摘录了分析数据，并与美国监测、流行病学和最终结果计划数据库中的数据进行了比较。对女性乳腺癌年龄特异性发病率进行线性回归分析，对乳腺癌年龄特异性病理特征进行逻辑回归分析。所有统计检验均为双侧检验。
结果：与女性结直肠癌不同，东亚女性年龄在 59 岁及以下的乳腺癌年龄特异性发病率在过去几十年中与美国同期相比不成比例地增加。在 2010-2014 年，美国患者中雌激素受体阳性的年龄特异性概率随年龄增加而增加，而三阴性乳腺癌（TNBC）的概率随年龄下降。东亚患者中没有出现类似的趋势；她们在 40-49 岁时雌激素受体阳性的概率显著更高（比值比 [OR] = 1.50，95%置信区间 [CI] = 1.36 至 1.67，P <.001），TNBC 的概率显著更低（OR = 0.79，95%CI = 0.71 至 0.88，P <.001），而在 50-59 岁时雌激素受体阳性的概率显著更低（OR = 0.88，95%CI = 0.828 至 0.95，P <.001）。对美国监测、流行病学和最终结果数据的亚组分析显示，东亚裔美国人和白种裔美国患者之间也存在类似的明显差异。
结论：东亚和美国女性以及东亚裔美国人和白种裔美国女性乳腺癌在年龄特异性发病率和病理特征方面存在差异，表明生物学上存在种族差异。
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