Highlights
- •We observed rising oestrogen receptor–positive (ER+) and falling ER− age-standardised breast cancer incidence rates in Ireland.
- •Human epidermal growth factor receptor 2 (HER2) status did not substantively impact receptor-specific trends.
- •Divergent ER± incidence rates across populations, suggest influences of similar factors with dual effects on ER+ and ER− cancers.
Abstract
The aetiology and clinical behaviour of breast cancers vary by oestrogen receptor
(ER) expression, HER2 expression and over time. Data from the United States and Denmark
show rising incidence rates for ER+ and falling incidence rates for ER– breast cancers.
Given that Ireland is a somewhat similar Western population but with distinctive risk
exposures (especially for lactation), we analysed breast cancer trends by ER status;
and for the first time, by the joint expression of ER±/HER2±. We assessed invasive
breast cancers (n = 24,845; 2004–2013) within the population-based National Cancer
Registry of Ireland. The population at risk was obtained from the Irish Central Statistics
Office (n = 10,401,986). After accounting for missing ER and HER2 data, we assessed
receptor-specific secular trends in age-standardised incidence rates (ASRs) with the
estimated annual percentage change (EAPC) and corresponding 95% confidence intervals
(95% CI). Age-period-cohort models were also fitted to further characterise trends
accounting for age, calendar-period and birth-cohort interactions. ASRs increased
for ER+ (EAPC: 2.2% per year [95% CI: 0.97, 3.45%/year]) and decreased for ER– cancers
(EAPC: −3.43% per year [95% CI: −5.05, −1.78%/year]), as well as for specific age
groups at diagnosis (<30–49, 50–64 and ≥65 years). ER+/HER2– cancers rose, ER+/HER2+
cancers were statistically flat and ER–/HER± cancers declined. Secular trends for
ER± cancers in Ireland were like those previously observed. Stratification by HER2±
expression did not substantively alter ER± trends. The divergence of ER± incidence
rates among independent Western populations likely reflects calendar-period and/or
risk factor changes with differential effects for ER+ and ER– breast cancers.
Keywords
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Article info
Publication history
Published online: October 23, 2017
Accepted:
August 25,
2017
Received in revised form:
August 21,
2017
Received:
July 20,
2017
Footnotes
☆Study presentation: This study was presented at the Irish Association for Cancer Research Annual Meeting 2017 and the American Association of Cancer Research Annual Meeting 2017.
Identification
Copyright
Published by Elsevier Ltd.
