Lee Argov Erica J, Lui Michelle L, Karr Anita G, Tehranifar Parisa, Kehm Rebecca D
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.
JAMA Netw Open. 2025 Jun 2;8(6):e2516947. doi: 10.1001/jamanetworkopen.2025.16947.
Breast cancer (BC) incidence trends are known to vary by race, ethnicity, and geography among younger women. Less is known about trends among older women (aged ≥65 years), who are typically aggregated, despite different screening guidelines for those older than 74 years.
To disaggregate US BC incidence trends among older women (ages 65-74, 75-84, and ≥85 years) according to stage at diagnosis, race and ethnicity, hormone receptor subtype, and geography.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study included women aged 65 years and older who were diagnosed with BC from January 2001 to December 2019. Data came from the US Cancer Statistics public use database, with information on women in all 50 US states. Data were analyzed from March to June 2024.
Age (65-74 years, 75-84 years, and ≥85 years).
Age-adjusted BC incidence rates were obtained, and average annual percent changes (AAPCs) from 2001 to 2019 were estimated using joinpoint regression for each age group, stratified by stage at diagnosis, race and ethnicity, and geography.
From 2001 to 2019, 2 278 611 women (1 249 750 [54.9%] aged 65-74 years; 119 287 [5.2%] Hispanic [all races], 205 738 [9.0%] non-Hispanic Black, and 1 826 084 [80.1%] non-Hispanic White) were diagnosed with BC. Age-adjusted BC incidence rates were 530.4 (95% CI, 529.5 to 531.3) per 100 000 persons, 515.3 (95% CI, 514.2 to 516.5) per 100 000 persons, and 376.8 (95% CI, 375.3 to 378.2) per 100 000 persons for ages 65 to 74 years, 75 to 84 years, and 85 years and older, respectively. Annually, incidence rates increased in women aged 65 to 74 years (AAPC, 0.4%, 95% CI, 0.2% to 0.6%), remained stable in women aged 75 to 84 years, and decreased in women aged 85 years or older (AAPC, -1.1%, 95% CI, -1.4% to -0.8%). In women aged 65 to 74 years, the AAPC was 7 to 11 times higher in Hispanic, non-Hispanic American Indian or Alaska Native, non-Hispanic Asian or Pacific Islander, and non-Hispanic Black women compared with non-Hispanic White women. Across all age groups, regional stage diagnoses decreased (ages ≥65 years: AAPC, -0.8%, 95% CI, -1.1% to -0.5%), while distant stage diagnoses increased (ages ≥65 years: AAPC, 1.3%, 95% CI, 1.2% to 1.6%). Trends for in situ and localized diagnoses varied by age. Across all age groups, non-Hispanic Black women had the highest proportion of hormone receptor and ERBB2-negative cancers.
In this population-based cross-sectional analysis of BC incidence trends among older US women, racial and ethnic as well as stage-specific patterns differed across age groups, highlighting the importance of disaggregating BC incidence rates into age groups better aligned with screening guidelines. Future research is needed to directly examine the contribution of screening patterns to these trends and their impact on BC mortality.
已知年轻女性的乳腺癌（BC）发病率趋势因种族、族裔和地域而异。对于老年女性（年龄≥65岁）的发病率趋势了解较少，尽管74岁以上人群的筛查指南不同，但这些老年女性通常被合并统计。
根据诊断分期、种族和族裔、激素受体亚型及地域，对美国老年女性（65 - 74岁、75 - 84岁和≥85岁）的BC发病率趋势进行细分。
设计、设置和参与者：这项基于人群的横断面研究纳入了2001年1月至2019年12月期间被诊断为BC的65岁及以上女性。数据来自美国癌症统计公共使用数据库，包含美国所有50个州女性的信息。数据于2024年3月至6月进行分析。
年龄（65 - 74岁、75 - 84岁和≥85岁）。
获得年龄调整后的BC发病率，并使用Joinpoint回归估计2001年至2019年各年龄组的年均变化百分比（AAPC），按诊断分期、种族和族裔以及地域进行分层。
2001年至2019年，共有2278611名女性被诊断为BC（1249750名[54.9%]年龄在65 - 74岁；西班牙裔[所有种族]119287名[5.2%]，非西班牙裔黑人205738名[9.0%]，非西班牙裔白人1826084名[80.1%]）。年龄调整后的BC发病率分别为每10万人530.4（95%CI，529.5至531.3）、每10万人515.3（95%CI，514.2至516.5）和每10万人376.8（95%CI，375.3至378.2），对应年龄分别为65至74岁、75至84岁和85岁及以上。每年，65至74岁女性的发病率上升（AAPC，0.4%，95%CI，0.2%至0.6%），75至84岁女性的发病率保持稳定，85岁及以上女性的发病率下降（AAPC， - 1.1%，95%CI， - 1.4%至 - 0.8%）。在65至74岁的女性中，西班牙裔、非西班牙裔美国印第安人或阿拉斯加原住民、非西班牙裔亚裔或太平洋岛民以及非西班牙裔黑人女性的AAPC比非西班牙裔白人女性高7至11倍。在所有年龄组中，区域分期诊断减少（年龄≥65岁：AAPC， - 0.8%，95%CI， - 1.1%至 - 0.5%），而远处分期诊断增加（年龄≥65岁：AAPC，1.3%，95%CI，1.2%至1.6%）。原位和局部诊断的趋势因年龄而异。在所有年龄组中，非西班牙裔黑人女性的激素受体和ERBB2阴性癌症比例最高。
在这项基于人群的美国老年女性BC发病率趋势横断面分析中，种族和族裔以及特定分期模式在不同年龄组中存在差异，凸显了将BC发病率细分为与筛查指南更匹配的年龄组的重要性。未来需要开展研究，直接考察筛查模式对这些趋势的贡献及其对BC死亡率的影响。
