Comparison of age distribution patterns for different histopathologic types of breast carcinoma.
BACKGROUND
Historically, female breast carcinoma has been viewed as an etiologically homogeneous disease associated with rapidly increasing incidence rates until age 50 years, followed by a slower rate of increase among older women. More recent studies, however, have shown distinct age incidence patterns for female breast cancer when stratified by estrogen receptor (ER) expression and/or histopathologic subtypes, suggesting etiologic heterogeneity.


METHODS
To determine if different age incidence patterns reflect etiologic heterogeneity (more than one breast cancer type within the general breast carcinoma), we applied "smoothed" age histograms at diagnosis (density plots) and a two-component statistical mixture model to all breast carcinoma cases (n = 270,124) in the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. These overall patterns were then reevaluated according to histopathologic type, race, and ER expression.


RESULTS
A bimodal age distribution at diagnosis provided a better fit to the data than a single density for all breast carcinoma populations, except for medullary carcinoma. Medullary carcinomas showed a single age distribution at diagnosis irrespective of race and/or ER expression.


CONCLUSIONS
Distinct age-specific incidence patterns reflected bimodal breast cancer populations for breast carcinoma overall as well as for histopathologic subtypes, race, and ER expression. The one exception was medullary carcinoma. Of note, medullary carcinomas are rare tumors, which are associated with germ-line mutations in the BRCA1 gene. These descriptive and model-based results support emerging molecular data, suggesting two main types of breast carcinoma in the overall breast cancer population.
Anderson
William F
WF
Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, EPS, Room 8036, 6120 Executive Boulevard, Bethesda, MD 20892-7244, USA. wanderso@mail.nih.gov
Pfeiffer
Ruth M
RM
Dores
Graça M
GM
Sherman
Mark E
ME
D000230:Adenocarcinoma / Q000737:chemistry / Q000453:epidemiology* / Q000473:pathology*; D002288:Adenocarcinoma, Mucinous / Q000453:epidemiology / Q000473:pathology; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000737:chemistry / Q000453:epidemiology* / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology / Q000473:pathology; D018275:Carcinoma, Lobular / Q000453:epidemiology / Q000473:pathology; D018276:Carcinoma, Medullary / Q000453:epidemiology / Q000473:pathology; D002291:Carcinoma, Papillary / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008875:Middle Aged; D009367:Neoplasm Staging; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012042:Registries; D018426:SEER Program; D014481:United States / Q000453:epidemiology
D011960:Receptors, Estrogen; D011980:Receptors, Progesterone