National Trends in Stage-Specific Breast Cancer Incidence Rates and Surgical Treatment
*Carina Zhang , *Julia Burns MD, *Jennifer Chen B.A., M.S., *Brian Sprague PhD., Michelle Sowden MD
Surgery, University of Vermont Medical Center, Burlington, VT
Numerous areas of the United States have experienced declines in mammography screening utilization, dating back to the controversial 2009 changes to the United States Preventive Services Task Force (USPSTF) breast cancer screening guidelines. In light of this decline, we investigated national trends in breast cancer stage at diagnosis and surgical treatment patterns to assess whether advanced stage of disease and invasive surgical treatments have become more common.
The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) was used to obtain diagnosis counts for in situ (DCIS), localized, regional, and distant stage breast cancers in women over 40 from 2004-2019, and counts of diagnoses treated with partial mastectomy (PM), total mastectomy (TM), and total mastectomy with reconstruction (TMR). Stage-specific incidence and surgery rates were calculated by age group (40-49, 50-74, 75+). Rates for the 50-74 group were age adjusted with the 2000 US Standard Population. Joinpoint Trend Analysis was used to estimate the annual percent change (APC) in the age- and stage-specific incidence and surgery rates.
Rates of DCIS have decreased among women of all ages since 2009 (e.g. APC=-0.69 [95% Confidence Interval (CI) -2.77, -0.18] for women aged 50-74 years). From 2004 to 2019, localized cancer rates increased in ages 40-49 (APC=1.14 [CI 0.82, 1.47]) and ages 50-74 (APC=1.18 [CI 1.02 to 1.34]). Among women 75+, the localized cancer rate increased from 2004-2011 (APC=0.58 [CI 0.3 to 1.41]) and 2017-2019 (APC=3.34 [CI 1.71, 4.53]). Regional cancer rates decreased or did not change across all ages. Distant cancer rates have been steady since 2012 in women aged 40-49 and 50-74 years but increased among women aged 75+ years from 2004-2019 (APC=1.40 [CI 1.00 to 1.82]).
Among women with DCIS, rates of PM have been relatively stable since 2004. During the study period, increases in TMR were observed among women aged 40-49 with DCIS (APC=11.31 [CI: 0.72, 14.08] from 2006-2013) and women aged 50-74 with DCIS (APC=10.58 [CI 8.89, 13.61] during 2004-2013), with subsequent declines in TM alone. Among women with localized cancer, the rates of PM declined in both women aged 40-49 (APC=-3.07 [CI: -3.72, -2.58] from 2004-2012) and women aged 50-74 (APC=- 0.77 [CI: -2.96, -0.03] from 2004-2012) with concurrent increases in both TM across all ages (e.g., APC=6.58 [CI: 4.69, 9.33} for women aged 50-74 and TMR in women ages 40-49 (APC=16.90 [CI: 15.46, 18.91]) and ages 50-74 (APC=20.17 [CI: 16.5, 33.16]).
Rates of DCIS have declined in the US, possibly correlated to the decline in mammography screening since 2009. There has been a steady increase in localized cancers dating prior to the 2009 guideline changes and no increases in regional or distant cancers, except among women aged 75+ years. Among women aged 40-74 diagnosed with DCIS and localized breast cancer, there has been a general trend towards increased rates of TMR rather than TM alone.
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