Age-Related Crossover in Breast Cancer Incidence Rates Between Black and White Ethnic Groups

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Abstract
Although breast cancer incidence is higher in black women than in white women among women younger than 40 years, the reverse is true among those aged 40 years or older. This crossover in incidence rates between black and white ethnic groups has been well described, has not been completely understood, and has been viewed as an artifact. To quantify this incidence rate crossover, we examined data for 440 653 women with invasive breast cancer from the National Cancer Institute’s Surveillance, Epidemiology, and End Results database from January 1, 1975, through December 31, 2004. Data on invasive female breast cancers were stratified by race, age at diagnosis, year of diagnosis, and tumor characteristics. Standard descriptive analyses were supplemented with Poisson regression models, age–period–cohort models, and two-component mixture models. All statistical tests were two-sided. We observed qualitative (ie, crossing or reversing) interactions between age and race. That is, age-specific incidence rates overall (expressed as number of breast cancers per 100 000 woman-years) were higher among black women (15.5) than among white women (13.1) younger than 40 years (difference = 2.4, 95% confidence interval [CI] = 2.4 to 2.4), and then, age-specific rates crossed with rates higher among white women (281.3) than among black women (239.5) aged 40 years or older (difference = 41.8, 95% CI = 41.7 to 41.9). The black-to-white incidence rate crossover was observed for all tumor characteristics assessed, although the crossover occurred at earlier ages of diagnosis for low-risk tumor characteristics than for high-risk tumor characteristics. The incidence rate crossover between ethnic groups was robust (ie, reliable and reproducible) to adjustment for calendar period and birth cohort effects in age–period–cohort models (P < .001 for difference by race). Although this ecologic study cannot determine the individual-level factors responsible for the racial crossover in vital rates, it confirms that the age-related crossover in breast cancer incidence rates between black and white ethnic groups is a robust age-specific effect that is independent of period and cohort effects.