Trends in US BCa Mortality by Region 1950-1999

#B140 Trends in U.S. Breast Cancer Mortality Rates by Region, 1950-69 to 1990-99.

Susan R. Sturgeon,1 Catherine Schairer,2 Laure El ghormli,2 Dan Grauman,2 Susan Devesa.2

Univ. of Massachusetts,1 Amherst, MA, National Cancer Institute,2 Bethesda, MD.

Trends in breast cancer mortality rates for the nation as a whole have been well described but limited information is available on whether trends differ by region of the country (i.e. Northeast, Midwest, West and South).

Age-specific breast cancer mortality rates were calculated from 1950-69 to 1990-99 for whites and 1970-89 to 1990-99 for blacks for four census regions and 508 state economic areas of the United States.

Calendar-year trends in breast cancer mortality varied substantially by age group and race. For all age and race groups, however, there was a pattern of less favorable changes in the South than in other regions of the country, particularly the Northeast.

The historical pattern of rates high in the Northeast corridor, intermediate in the Midwest and West, and low across the South was especially attenuated over time among white women 50-64 years of age.

For these women, the relative risk [RR] for the Northeast compared to the South in 1950-59 was 1.48; the comparable figure for 1990-99 was 1.15.

Breast cancer mortality rates increased in all four regions from the 1950s to 1960s but more substantially in the South, continued to increase slightly in the 1970s in all four regions, declined slightly in the Northeast, Midwest and West but not in the South in the 1980s, and declined more substantially in the Northeast, Midwest and West than in the South in the 1990s.

Among similarly aged black women, the RR in 1970-89 was 1.13; the comparable figure for 1990-99 was 1.0. Among these women, rates increased in all four regions in the 1980s; in the 1990s rates declined in the Northeast, Midwest and West but still continued to increase in the South.

Conclusion: Attention has been largely focused on the higher breast cancer mortality rates in the Northeast relative to the rest of the country.

The historical advantage of the South has been eroded primarily because of less favorable breast cancer mortality trends in the South. Regional trends in fertility patterns are likely to explain some but perhaps not all of the comparatively less favorable mortality patterns in the South.

There is a clear need for monitoring regional trends in risk and prognostic factors, incidence and mortality rates, and medical care related to breast cancer.

Frontiers in Cancer Prevention Research, 2003 AACR

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