title: Comparison of quadrant-specific breast cancer incidence trends in the United States and England between 1975 and 2013.
abstract: UK breast cancer incidence rates suggest that upper outer quadrant (UOQ) cancers have risen disproportionately compared with other areas over time. We aimed to provide a comparison of the trend in quadrant-specific breast cancer incidence between the United States (US) and England, and determine whether a disproportionate UOQ increase is present.
  
  
  
  Surveillance Epidemiology and End Results (SEER) cancer registry data were obtained on 630,007 female breast cancers from 1975 to 2013. English cancer registry data were obtained on 1,121,134 female breast cancers from 1979 to 2013. Temporal incidence changes were analysed using negative binomial regression. Interaction terms determined whether incidence changes were similar between sites.
  
  
  
  English breast cancer incidence in the UOQ rose significantly from 13% to 28% from 1979 to 2013 whereas no significant increase was observed among SEER data. The significant interaction between quadrant and year of diagnosis (p<0.001) in both SEER and English data indicates that breast cancer incidence in each quadrant changed at a different rate. Incidence in the UOQ rose disproportionately compared to the nipple (SEER IRR=0.81, p<0.001; England IRR=0.78, p<0.001) and axillary tail (SEER IRR=0.87, p=0.018; England IRR=0.69, p<0.001) in both SEER and England. In addition, incidence rose disproportionately in the UOQ compared to non-site-specific tumours in England (Overlapping lesions IRR=0.81, p=0.002; NOS IRR=0.78, p<0.001). The proportion of non-site-specific tumours was substantially higher in England than SEER throughout the study period (62% in England; 39% in SEER).
  
  
  
  Breast cancer incidence in the UOQ increased disproportionately compared to non-site-specific tumours in England but not in SEER, likely due to the decrease in non-site-specific tumours observed in England over time. There may be real differences in incidence between the two countries, possibly due to differences in aetiology, but is much more likely to be an artefact of changing data collection methods and improvements in site coding in either country.
authors.affiliation: Centre for Childhood Cancer Survivor Studies, Institute Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham B15 2TT, UK. Electronic address: cxb362@bham.ac.uk.
authors.forename: C J
authors.initials: CJ
authors.lastname: Bright
authors.affiliation: Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: D W
authors.initials: DW
authors.lastname: Rea
authors.affiliation: Department of Surgery, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham B15 2TH, UK.
authors.forename: A
authors.initials: A
authors.lastname: Francis
authors.affiliation: Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK.
authors.forename: R G
authors.initials: RG
authors.lastname: Feltbower
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000145:classification / Q000453:epidemiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D018426:SEER Program / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Breast cancer; Data collection; Incidence trends; Quadrant; SEER; Upper outer quadrant