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Divergent oestrogen receptor-specific breast cancer trends in Ireland (2004–2013): Amassing data from independent Western populations provide etiologic clues

  • Author Footnotes
    1 Contributed equally as co-first authors.
    Maeve Mullooly
    Correspondence
    Corresponding author: Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892, USA. Tel.: +1240 276 6287.
    Footnotes
    1 Contributed equally as co-first authors.
    Affiliations
    Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
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  • Author Footnotes
    1 Contributed equally as co-first authors.
    Jeanne Murphy
    Footnotes
    1 Contributed equally as co-first authors.
    Affiliations
    George Washington University School of Nursing, Washington, DC, USA
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  • Gretchen L. Gierach
    Affiliations
    Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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  • Paul M. Walsh
    Affiliations
    National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
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  • Sandra Deady
    Affiliations
    National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
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  • Thomas I. Barron
    Affiliations
    Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, Trinity College, University of Dublin, Dublin, Ireland

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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  • Mark E. Sherman
    Affiliations
    Mayo Clinic, Jacksonville, FL, USA
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  • Author Footnotes
    2 Contributed equally as co-senior authors.
    Philip S. Rosenberg
    Footnotes
    2 Contributed equally as co-senior authors.
    Affiliations
    Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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  • Author Footnotes
    2 Contributed equally as co-senior authors.
    William F. Anderson
    Footnotes
    2 Contributed equally as co-senior authors.
    Affiliations
    Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
    Search for articles by this author
  • Author Footnotes
    1 Contributed equally as co-first authors.
    2 Contributed equally as co-senior authors.
Published:October 23, 2017DOI:https://doi.org/10.1016/j.ejca.2017.08.031

      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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