Li Christopher I, Daling Janet R, Malone Kathleen E
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
J Clin Oncol. 2003 Jan 1;21(1):28-34. doi: 10.1200/JCO.2003.03.088.
Between 1987 and 1998, breast cancer incidence rates rose 0.5%/yr in the United States. A question of potential etiologic and clinical importance is whether the hormone receptor status of breast tumors is also changing over time. This is because hormone receptor status may reflect different etiologic pathways and is useful in predicting response to adjuvant therapy and prognosis.
Age-adjusted, age-specific breast cancer incidence rates by estrogen receptor (ER) and progesterone receptor (PR) status from 1992 to 1998 were obtained and compared from 11 population-based cancer registries in the United States that participate in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program.
From 1992 to 1998, the overall proportion of breast cancers that were ER-positive and PR-positive increased from 75.4% to 77.5% (P =.0002) and from 65.0% to 67.7% (P <.0001), respectively, continuing trends observed before 1992. These increases were limited to women 40 to 69 years of age. The proportions of ER-positive/PR-positive tumors increased from 56.7% to 62.3% (P =.0010) among 40- to 49-year-olds, from 58.0% to 63.2% (P =.0002) among 50- to 59-year-olds, and from 63.2% to 67.9% (P =.0020) among 60- to 69-year-olds.
From 1992 to 1998, the proportion of tumors that are hormone receptor-positive rose as the proportion of hormone receptor-negative tumors declined. Because the incidence rates of hormone receptor-negative tumors remained fairly constant over these years, the overall rise in breast cancer incidence rates in the United States seems to be primarily a result of the increase in the incidence of hormone receptor-positive tumors. Hormonal factors may account for this trend.
1987年至1998年间,美国乳腺癌发病率以每年0.5%的速度上升。一个具有潜在病因学和临床重要性的问题是,乳腺肿瘤的激素受体状态是否也随时间发生变化。这是因为激素受体状态可能反映不同的病因途径,并且有助于预测辅助治疗的反应和预后。
从美国11个参与美国国立癌症研究所监测、流行病学和最终结果(SEER)计划的基于人群的癌症登记处获取并比较了1992年至1998年按雌激素受体(ER)和孕激素受体(PR)状态调整年龄后的特定年龄乳腺癌发病率。
1992年至1998年,雌激素受体阳性和孕激素受体阳性的乳腺癌总体比例分别从75.4%增至77.5%(P = 0.0002)和从65.0%增至67.7%(P < 0.0001),延续了1992年前观察到的趋势。这些增加仅限于40至69岁的女性。在40至49岁人群中,雌激素受体阳性/孕激素受体阳性肿瘤的比例从56.7%增至62.3%(P = 0.0010),在50至59岁人群中从58.0%增至63.2%(P = 0.0002),在60至69岁人群中从63.2%增至67.9%(P = 0.0020)。
1992年至1998年,激素受体阳性肿瘤的比例上升,而激素受体阴性肿瘤的比例下降。由于这些年激素受体阴性肿瘤的发病率保持相当稳定,美国乳腺癌发病率的总体上升似乎主要是激素受体阳性肿瘤发病率增加的结果。激素因素可能解释了这一趋势。