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Breast Cancer Incidence and Mortality Trends, Variation by State and Race/Ethnicity, and Association With Obesity, Physical Activity, and Mammography Screening in the United States
34 Pages Posted: 15 Nov 2021
More...Abstract
Background: Breast cancer causes disproportionate disease burden among various racial/ethnic groups in the United States. We aimed to investigate 1) temporal trends of breast cancer incidence and mortality; 2) state-level trends and racial variations; and 3) ecological correlations between obesity, physical activity, mammography screening, and breast cancer incidence and mortality trends in the US.&
Methods: Incidence and mortality data were obtained from the United States Cancer Statistics 1999 – 2017 Incidence and Mortality. Prevalence of obesity, physical activity, and mammography screening were obtained from the Behavioral Risk Factor Surveillance System. The join point model was used to estimate annual percent changes and average annual percent changes. Pearson correlation analyses were performed to test state-level ecological correlations of obesity, physical activity, and mammography screening with breast cancer incidence and mortality trends.
Findings: A significant reduction in breast cancer incidence (AAPC: -0.4%/year, p < 0.05) and mortality (AAPC: -1.7/year, p < 0.05) was observed during the period of 1999-2017. A striking state-level variation in breast cancer incidence and mortality between Whites and other races/ethnicities was observed, with higher disparity seen in the Southeast. A significant positive correlation was found between obesity and breast cancer incidence (r = 0.316, p = 0.024) and mortality (r = 0.40, p = 0.004), an inverse correlation between physical activity and incidence (r = -0.577, p < 0.001), and mammography screening and mortality trend (r = -0.641, p < 0.001).
Interpretation: There is a large state-level variation in racial/ethnic disparity. Metabolic and lifestyle factors and access to screening are important contributors to observed trend changes and racial disparities. Interventions targeting on these factors will likely help avert more breast cancer cases and deaths, particularly among minority women.
Funding Information: This work was supported by the Cancer Hospital of Shantou University Medical College Research Initiation Fund; Natural Science Foundation of Guangdong Province (grant numbers 2019A1515010239 & 2021A1515012178); Science and Technology Special Fund (190829105556145), and Strategic and Special Fund for Science and Technology Innovation of Guangdong Province, China (180918114960704); Guangdong Basic and Applied Basic Research Foundation (2019A1515110953); Shantou Municipal Health Science and Technology Fund (190819145262877); and Li-Ka-Shing Foundation (2020LKSFG05C). Yuanke Liang was supported by the China Postdoctoral Science Foundation (2020M672753).
Declaration of Interests: All authors declare no conflicts of interest.
Keywords: Breast cancer, incidence mortality trends, state variation, racial disparity, obesity, physical activity, mammography screening
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