Decline in US breast cancer rates after the Women's Health Initiative: socioeconomic and racial/ethnic differentials.
OBJECTIVE
We investigated whether there were socioeconomic and racial/ethnic disparities in recent reported declines in overall US breast cancer incidence rates attributed to post-2002 declines in hormone therapy use following publication of the Women's Health Initiative study.


METHODS
We analyzed 1992-2005 US breast cancer incidence data from the US Surveillance, Epidemiology and End Result (SEER) 13 Registries Database, stratified by race/ethnicity, county income level, age, and estrogen receptor (ER) status.


RESULTS
As we hypothesized, between 1992 and 2005, the temporal pattern of rising and then falling US breast cancer incidence rates occurred only among White non-Hispanic women who lived in high-income counties, were aged 50 years and older, and had ER-positive tumors. No such trends were evident--regardless of county income level, ER status, or age--among Black non-Hispanic, Asian/Pacific Islander, Hispanic, or-where numbers were sufficient to conduct meaningful analyses-American Indian/Alaska Native women.


CONCLUSIONS
The recent decline in US breast cancer incidence was not equally beneficial to all women, but instead mirrored the social patterning of hormone therapy use. Joint information on socioeconomic resources and race/ethnicity is vital for correctly understanding disease distribution, including that of breast cancer.
Department of Society, Human Development and Health, Harvard School of Public Health, Kresge 717, 677 Huntington Ave, Boston, MA 02115, USA. nkrieger@hsph.harvard.edu
Nancy
N
Krieger
Jarvis T
JT
Chen
Pamela D
PD
Waterman
D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology*; D005260:Female; D054624:Health Status Disparities; D020249:Hormone Replacement Therapy; D006801:Humans; D033181:Information Dissemination; D008875:Middle Aged; D015995:Prevalence; D044469:Racial Groups; D011960:Receptors, Estrogen / Q000097:blood; D012042:Registries; D018426:SEER Program; D012923:Social Class; D014481:United States / Q000453:epidemiology
D011960:Receptors, Estrogen