从 1935 年到 2015 年美国 40 岁以下女性的生育力与乳腺癌发病率趋势。
Trends in Parity and Breast Cancer Incidence in US Women Younger Than 40 Years From 1935 to 2015.
机构信息
Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York.
Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford.
出版信息
JAMA Netw Open. 2020 Mar 2;3(3):e200929. doi: 10.1001/jamanetworkopen.2020.0929.
IMPORTANCE
During the past several decades, breast cancer incidence has been increasing for women younger than 40 years. The increase matches the decrease in parity, an established breast cancer risk factor, but secular trends in incidence have not been examined prior to the 1970s.
OBJECTIVE
To examine whether secular trends in parity explain the increase in breast cancer incidence among US women aged 25 to 39 years from 1935 to 2015.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used population-based aggregate-level data from the Connecticut Tumor Registry (CTR) to examine breast cancer incidence and age-standardized rates among women aged 25 to 39 years from 1935 to 2015. National mean live births were calculated using birth data from the National Vital Statistics System (NVSS) from 1930 to 2015 (allowing for 5-year lag). Linear regression was used to compare a baseline model of year estimating age-adjusted breast cancer incidence rate with a model that adjusted for parity constructs.
MAIN OUTCOMES AND MEASURES
Breast cancer incidence rates among women aged 25 to 39 years from 1935 to 2015.
RESULTS
Among women in Connecticut aged 25 to 39 years from 1935 to 2015, incidence of breast cancer for women aged 25 to 39 years increased 0.65% (95% CI, 0.53%-0.77%) per year, from 16.3 breast cancer diagnoses per 100 000 women in 1935 to 38.5 breast cancer diagnoses per 100 000 women in 2015. This increase began nearly 4 decades before the secular decrease in parity (mean [SD] parity peaked at 2.26 [0.87] live births per woman in 1966 and in 2010 had decreased to 1.41 [0.71] live births per woman). Age-specific parity trends explained only 0% to 4% of the variability in incidence over time.
CONCLUSION AND RELEVANCE
These findings suggest that breast cancer incidence for women aged 25 to 39 years has been significantly increasing since the 1930s and cannot be attributed to changes in parity over time.
重要性
在过去几十年中，40 岁以下女性的乳腺癌发病率一直在上升。这种增长与已确定的乳腺癌风险因素之一的生育次数减少相吻合，但在 20 世纪 70 年代之前，尚未对发病趋势进行过研究。
目的
检验 20 世纪 30 年代至 2015 年期间，美国 25 至 39 岁女性的生育变化是否可以解释乳腺癌发病率的上升。
设计、地点和参与者：本基于人群的队列研究使用了康涅狄格州肿瘤登记处（CTR）的基于人群的综合水平数据，以检查 1935 年至 2015 年期间 25 至 39 岁女性的乳腺癌发病率和年龄标准化率。利用全国生命统计系统（NVSS）的出生数据（1930 年至 2015 年）计算出全国平均活产数（允许有 5 年的滞后）。线性回归用于比较按年份估算年龄调整后乳腺癌发病率的基本模型和调整生育结构的模型。
主要结局和测量指标
1935 年至 2015 年期间，25 至 39 岁女性的乳腺癌发病率。
结果
在康涅狄格州年龄在 25 至 39 岁的女性中，1935 年至 2015 年期间，年龄在 25 至 39 岁的女性乳腺癌发病率每年增加 0.65%（95%CI，0.53%-0.77%），从 1935 年的每 10 万名妇女中有 16.3 例乳腺癌诊断增加到 2015 年的每 10 万名妇女中有 38.5 例乳腺癌诊断。这种增长几乎在生育力下降的 40 年前就开始了（平均[SD]生育高峰出现在 1966 年，每名妇女有 2.26[0.87]活产，2010 年下降到每名妇女有 1.41[0.71]活产）。特定年龄的生育力趋势仅解释了随时间变化的发病率变化的 0%至 4%。
结论和相关性
这些发现表明，自 20 世纪 30 年代以来，25 至 39 岁女性的乳腺癌发病率一直在显著上升，这不能归因于生育力随时间的变化。
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