title: Breast cancer clustering in Kanagawa, Japan: a geographic analysis.
abstract: BACKGROUND
  The purpose of the present study was to determine geographic clustering of breast cancer incidence in Kanagawa Prefecture, using cancer registry data. The study also aimed at examining the association between socio-economic factors and any identified cluster.
  
  
  METHODS
  Incidence data were collected for women who were first diagnosed with breast cancer during the period from January to December 2006 in Kanagawa. The data consisted of 2,326 incidence cases extracted from the total of 34,323 Kanagawa Cancer Registration data issued in 2011. To adjust for differences in age distribution, the standardized mortality ratio (SMR) and the standardized incidence ratio (SIR) of breast cancer were calculated for each of 56 municipalities (e.g., city, special ward, town, and village) in Kanagawa by an indirect method using Kanagawa female population data. Spatial scan statistics were used to detect any area of elevated risk as a cluster for breast cancer deaths and/ or incidences. The Student t-test was performed to examine differences in socio-economic variables, viz, persons per household, total fertility rate, age at first marriage for women, and marriage rate, between cluster and other regions.
  
  
  RESULTS
  There was a statistically significant cluster of breast cancer incidence (p=0.001) composed of 11 municipalities in southeastern area of Kanagawa Prefecture, whose SIR was 35 percent higher than that of the remainder of Kanagawa Prefecture. In this cluster, average value of age at first-marriage for women was significantly higher than in the rest of Kanagawa (p=0.017). No statistically significant clusters of breast cancer deaths were detected (p=0.53).
  
  
  CONCLUSIONS
  There was a statistically significant cluster of high breast cancer incidence in southeastern area of Kanagawa Prefecture. It was suggested that the cluster region was related to the tendency to marry later. This study methodology will be helpful in the analysis of geographical disparities in cancer deaths and incidence.
authors: Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center Research Institute, Japan E-mail : suketomo.hiroko@jwcpe.ac.jp.
authors: Kayoko
authors: K
authors: Katayama
authors: Kazuhito
authors: K
authors: Yokoyama
authors: Hiroko
authors: H
authors: Yako-Suketomo
authors: Naoyuki
authors: N
authors: Okamoto
authors: Toshiro
authors: T
authors: Tango
authors: Yutaka
authors: Y
authors: Inaba
mesh_terms: D000328:Adult; D000367:Age Factors; D001723:Birth Rate; D001943:Breast Neoplasms / Q000453:epidemiology*; D002947:Cities / Q000453:epidemiology; D016000:Cluster Analysis; D005191:Family Characteristics; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008393:Marriage; D012042:Registries; D012959:Socioeconomic Factors; D062206:Spatial Analysis