Figures 2013-201
`
`Breast: Cancer
`Facts
`
`_,
`
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`
`
` ' American
`
`Cancer
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`IMMUNOGEN 2205, pg. 1
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`IMMUNOGEN 2205, pg. 1
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`Contents
`Breast Cancer Basic Facts............................................................................................................................1
`Breast Cancer Occurrence...........................................................................................................................4
`Breast Cancer Risk Factors.............................................................................................................................11
`
`g
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`2
`
`Breast Cancer Screening...........................................................................................................................18
`
`Breast Cancer Treatment................................................................................................................................23
`what is the American Cancer Society doing about breast cancer?..............................................................26
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`
`Sources of Statistics..................................................................................................................................29
`References................................................................................................................................................30
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`The production of this report would not have been possible without the efforts of:
`
`Rick Alteri, MD; Cammie Barnes, MBA; Adriane Burke, MPH; Ted Gansler, MD, MPH; Susan Gapstur, PhD; Mia Gaudet, PhD; Joan Kramer,
`MD; Lisa A Newman, MD, MPH; Dearell Niemeyer, MPH; Cheri Richards, MS; Carolyn Runowicz, MD; Debbie Saslow, PhD; Scott Simpson;
`Robert Smith, PhD; Kristen Sullivan, MS, MPH; Dana Wagner; Jiaquan Xu, MD.
`
`Breast Cancer Facts & Figures 2013-2074 is a publication of the American Cancer Society, Atlanta, Georgia.
`
`Atlanta, GA 30303—1002.
`
`Corporate Center: American Cancer Society Inc.
`250 Williams Street, NWr Atlanta, GA 30303-1002
`(404) 320-3333
`©2013, American Cancer Society, inc, All rights reserved,
`including the right to reproduce this publication
`or portions thereof in any form,
`For written permission, address the Legal department of
`the American Cancer Society, 250 Williams Street, NW,
`
`This publication attempts to summarize current scientific information about breast cancer.
`
`Except when specified, it does not represent the official policy of the American Cancer Society.
`
`Suggested citation: American Cancer Society. Breast Cancer Facts & Figures 2013-2014. Atlanta:
`American Cancer Society, Inc. 2013.
`
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`What is breast cancer?
`
`Cancer is a group of diseases that cause cells in the body to
`change and grow out of control. Most types of cancer cells even-
`tually form a lump or mass called a tumor, and are named after
`the part of the body where the tumor originates.
`
`Breast cancer begins in the breast tissue that is made up of
`glands for milk production, called lobules, and the ducts that
`connect the lobules to the nipple. The remainder of the breast is
`made up of fatty, connective, and lymphatic tissues.
`
`Breast cancer typically is detected either during a screening
`examination, before symptoms have developed, or after symp—
`toms have developed, when a woman feels a lump. Most masses
`seen on a mammogram and most breast lumps turn out to be
`benign; that is, they are not cancerous, do not grow uncontrol-
`lably or spread, and are not life-threatening. When cancer is
`suspected based on clinical breast exam or breast imaging,
`microscopic analysis of breast tissue is necessary for a definitive
`diagnosis and to determine the extent of spread (in situ or inva-
`sive) and characterize the pattern of the disease. The tissue for
`microscopic analysis can be obtained via a needle or surgical
`biopsy. Selection of the type of biopsy is based on individual
`patient clinical factors, availability of particular biopsy devices,
`and resources.
`
`is skim
`
`- Ductal carcinoma in situ (DCIS) is a spectrum of abnormal
`breast changes that start in the cells lining the breast ducts.
`DCIS is considered a noninvasive form of breast cancer
`
`because the abnormal cells have not grown beyond the layer
`of cells where they originated. It is the most common type of
`in situ breast cancer, accounting for about 83% of in situ cases
`diagnosed during 2006—2010. DCIS may or may not progress to
`
`
`
`
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`Deaths
`Invasive Cases
`In Situ Cases
`Age (Yrs)
`1,020
`10,980
`1,900
`<40
`4,780
`48,910
`15,650
`<50
`50—64
`26,770
`84,210
`11,970
`
`65+
`22,220
`99,220
`22,870
`
`All ages
`64,640
`232,340
`39,620
`*Rounded to the nearest 10.
`Source: Total estimated cases are based on 1995-2009 incidence rates from
`49 states as reported by the North American Association for Central Cancer
`Registries, iotai estimated deaths are based on data from US Mortality Data,
`1995—2009, National Center for Health Statistics, Centers for Disease Control
`and Prevention.
`American Cancer Society, Surveillance and Health Services Research, 2013
`
`invasive cancer; in fact, some of these tumors grow so slowly
`that even without treatment they would not affect a woman’s
`health. Studies suggest that about one—third, and possibly more,
`ofDCIS cases will progress to invasive cancer if left untreated.1
`Identifying subtypes of DCIS that are most likely to recur or
`progress to invasive cancer is an active area of research.2
`
`. Lobular carcinoma in situ (LCIS, also known as lobular
`neoplasia) is not a true cancer or precancer, but an indicator
`of increased risk for developing invasive cancer. LCIS is much
`less common than DCIS, accounting for about 12% of female
`in situ breast cancers diagnosed during 2006—2010. See page
`12 for more information on LCIS.
`
`- Other in situ breast cancers have characteristics of both ductal
`
`and lobular carcinomas or have unknown origins.
`
`invasive
`
`Most breast cancers are invasive, or infiltrating. These cancers
`have broken through the ductal or glandular walls where they
`originated and grown into surrounding breast tissue.
`
`The prognosis (forecast or outcome) of invasive breast cancer is
`strongly influenced by the stage of the disease - that is, the
`extent or spread of the cancer when it is first diagnosed. There
`are two main staging systems for cancer. The TNM classifica—
`tion of tumors uses information on tumor size and how far it has
`
`spread Within the breast (T), the extent of spread to the nearby
`lymph nodes (N), and the presence or absence of distant metas-
`tases (spread to distant organs) (M).3 Once the T, N, and M are
`determined, a stage of 0, I, II, III, or IV is assigned, with stage 0
`being in situ, stage I being early stage invasive cancer, and stage
`IV being the most advanced disease. The TNM staging system is
`commonly used in clinical settings.
`
`The Surveillance, Epidemiology, and End Results (SEER) Sum-
`mary Stage system is more simplified and is commonly used in
`reporting cancer registry data and for public health research
`and planning.4
`
`According to this system:
`
`< Local stage refers to cancers that are confined to the breast
`(corresponding to stage I and some stage II cancers in the
`TNM staging system).
`
`» Regional stage refers to tumors that have spread to surround-
`ing tissue or nearby lymph nodes (generally corresponding
`to stage II or III cancers, depending on size and lymph node
`involvement).
`
`. Distant stage refers to cancers that have metastasized
`(spread) to distant organs or lymph nodes above the collar—
`bone (corresponding to stages 1110 and IV).
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`. Luminal B. About 10% to 20% of breast cancers are luminal
`
`B.8'lo Like luminal A tumors, most luminal B tumors are ER+
`
`and/or PR+, but they are distinguished by either expression
`of HER2 or high proliferation rates (high numbers of cancer
`cells actively dividing)”
`
`- Basal-like. About 10% to 20% of breast cancers are basal-like,
`and the majority of basal-like breast cancers are referred to
`as “triple negative” because they are ER-, PR-, and HERZ—.1°'12
`Basal-like tumors are more common in African American
`
`women, premenopausal women, and those with aBRCAI gene
`mutation.8 Women diagnosed with basal—like breast cancer
`have a poorer short—term prognosis than those diagnosed
`with other breast cancer types because there are no targeted
`therapies for these tumors.
`
`HERZ enriched. About 10% of breast cancers produce excess
`HER2 (a growth—promoting protein) and do not express
`hormone receptors (EFi— and PR—).8 Similar to the basal-like
`subtype, these cancers tend to grow and spread more
`aggressively than other breast cancers and are associated
`with poorer short term prognosis compared to ER+ breast
`cancers.9 However, the use of targeted therapies for HER2+
`cancers has reversed much of the adverse prognostic impact
`of HER2 overexpression. For more information about the
`treatment of HER2+ breast cancers, see the section on
`
`targeted therapy on page 25.
`
`What are the signs and symptoms
`of breast cancer?
`
`Breast cancer typically produces no symptoms When the tumor
`is small and most easily cured. Therefore, it is very important for
`women to follow recommended screening guidelines for detect—
`ing breast cancer at an early stage. When breast cancer has
`grown to a size that can be felt, the most common physical sign
`is a painless lump. Sometimes breast cancer can spread to
`underarm lymph nodes and cause a lump or swelling, even
`before the original breast tumor is large enough to be felt. Less
`common signs and symptoms include breast pain or heaviness;
`persistent changes to the breast, such as swelling, thickening, or
`redness of the breast’s skin; and nipple abnormalities such as
`spontaneous discharge (especially if bloody), erosion, inversion,
`or tenderness. It is important to note that pain (or lack thereof)
`does not indicate the presence or the absence of breast cancer.
`Any persistent abnormality in the breast should be evaluated by
`a physician as soon as possible.
`
`Sources: Incidence: North American Association of Central Cancer Registries.
`Mortality: National Center for Health Statistics, Centers for Disease Control
`and Prevention, as provided by the Suveillance, Epidemiology, and End Results
`Program, National Cancer Institute.
`American Cancer Society, Surveillance and Health Services Research, 2013
`
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`Breast cancer is increasingly considered to be not one disease,
`but a group of diseases distinguished by different molecular
`subtypes, risk factors, clinical behaviors, and responses to treat—
`ment. Distinct molecular subtypes of breast cancer have been
`identified using gene expression profiles, a process tlaat is both
`complex and costly.5 More convenient approximations of molec—
`ular subtypes have been identified using biological markers,
`including the presence or absence of estrogen receptors (ER+/
`ER—), progesterone receptors (PR+/PR-), and human epidermal
`growth factor receptor 2 (HER2+/HER2-).6 Molecular subtypes
`are increasingly being used for research purposes; however,
`questions remain about their usefulness to further tailor breast
`
`cancer treatments and predict breast cancer prognosisfi7
`
`a Luminal A. About 40% of breast cancers are luminal A,
`
`making it the most common breast cancer subtype.8 These
`tumors tend to be ER+ and/or PR+ and HER2~, slow—growing,
`and less aggressive than other subtypes. Luminal A tumors
`are associated with the most favorable short-term prognosis,
`in part because expression of hormone receptors is predictive
`of a favorable response to hormonal therapy (see page 25);
`however, long—term survival is similar to or even lower than
`some other subtypes.9
`
`
`
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`"286% 2:. genrzaée 228.2%? (tamer Emitteme and Moz‘taiéty Rate? 6;: Race, gtt‘micity. and 8mm, 282282836
`African American
`Incidence
`Mortality
`
`Incidence
`
`Mortality
`
`Non-Hispanic White
`Incidence
`Mortality
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`Hispanic
`
`State
`Alabama
`Alaska
`Arizona
`Arkansas
`California
`Colorado
`Connecticut
`Delaware
`Dist. of Columbia*
`Florida
`
`Georgia
`Hawaii
`Idaho
`Illinois
`Indiana
`Iowa
`Kansas
`Kentucky
`Louisiana
`Maine
`
`Maryland
`Massachusetts§
`Michigan
`Minnesotall
`Mississippi
`Missouri
`Montana
`Nebraska
`Nevada
`New Hampshire
`New Jersey
`New Mexico
`New York
`North Carolina
`North Dakota’
`Ohio
`Oklahoma
`Oregon
`Pennsylvania
`Rhode Island
`South Carolina‘
`South Dakota
`Tennessee
`Texas
`Utah
`Vermont
`Virginia
`Washington
`West Virginia
`Wisconsin
`Wyoming
`United States”
`
`117.9
`130.7
`117.1
`109.6
`
`21.0
`25.2
`21.5
`22.3
`
`
`
`22.7
`
`121.2
`147.5
`95.7
`100.8
`120.7
`121.5
`110.9
`126.7
`133.6
`105.4
`120.9
`128.5
`T
`123.4
`117.6
`114.0
`124.0
`129.4
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`125.7“
`97.7
`119.4
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`117.3
`130.9
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`122.8
`103.7
`107.3
`117.1
`83.4
`109.0
`123.0
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`116.2
`129.4
`106.7
`127.8
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`122.7
`117.2
`96.7
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`127.3
`116.4
`105.7
`116.5
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`118.4
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`31.5
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`27.7
`32.9
`31.8
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`21.9
`33.4
`32.4
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`26.6
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`30.9
`T
`25.8
`29.9
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`31.6
`34.7
`22.0
`32.1
`19.7
`29.8
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`35.4
`33.5
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`T
`33.2
`24.5
`25.8
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`30.8
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`56.8
`90.3
`84.4
`50.7
`89.9
`98.3
`119.6
`112.8
`71.8
`96.5
`85.8
`112.9
`80.2
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`87.2
`70.9
`68.8
`88.7
`60.5
`80.0
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`
`*Rates are per 100,000 and age adjusted to 2000 US standard population. TStatistic not displayed due to fewer than 25 cases or deaths. TMortaIity rates for white
`women in these states are not exclusive of Hispanic origin and are not shown for Hispanic women due to unreliable ethnicity data. § he incidence rate for white women
`in Massachusetts is not exclusive of Hispanic origin and is not available for Hispanic women. 11This state’s registry did not submit 2006-2010 incidence data to the North
`American Association of Central Cancer Registries. TT Overall US incidence rates do not include data from Arkansas, Minnesota, Nevada, Ohio, and Virginia.
`Sources: Incidence: Copeland et al.‘5 Mortality: National Center for Health Statistics, Centers for Disease Control and Prevention, as provided by the Surveillance,
`Epidemiology, and End Results Program, National Cancer Institute.
`
`American Cancer Society, Surveillance and Health Services Research, 2013
`
`
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`1 in 11. This increase in risk is due to longer life expectancy,
`as well as increases in breast cancer incidence due in part
`to changes in reproductive patterns, menopausal hormone
`use, the rising prevalence of obesity, and increased detection
`through screening. Lifetime risk reflects an average woman's
`risk over an entire lifetime, including the possibility that she
`may die from another cause before she would have been diag—
`nosed with breast cancer, and should not be confused with
`
`risk over a shorter time period.
`
`Rereefitfiaésity
`
`Breast cancer incidence rates are higher in non—Hispanic
`white women than African American women for most age
`groups (Figure 1, page 2). However, African American women
`have a higher incidence rate before age 40 and are more likely
`to die from breast cancer at every age. In addition, African
`American women have lower rates of ER+ breast cancer and
`
`higher rates of ER— breast cancer than white women in every
`age group.
`
`. Figure 2 shows breast cancer incidence and death rates by
`race and ethnicity during the most recent time period (2006—
`2010).”-15 Incidence and death rates for breast cancer are
`lower among women of other racial and ethnic groups than
`among non—Hispanic white and African American women.
`Asian/Pacific Islander women have the lowest incidence and
`death rates.
`
`IMMUNOGEN 2205. pg. 6
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`How many cases and deaths are estimated
`to occur in 2013?
`
`a In 2013, an estimated 232,340 new cases ofinvasive breast
`
`cancer will be diagnosed among women, as well as an
`estimated 64,640 additional cases of in situ breast cancer
`
`(Table 1, page 1).
`
`-
`
`In 2013, approximately 39,620 women are expected to
`die from breast cancer (Table 1, page 1). Only lung cancer
`accounts for more cancer deaths in women.
`
`a In 2013, about 2,240 men will be diagnosed with breast
`cancer and 410 men will die from the disease.
`
`How many women alive today have
`ever had breast cancer?
`
`More than 2.9 million US women with a history of breast cancer
`were alive on January 1, 2012.13 Some of these women were cancer-
`free, while others still had evidence of cancer and may have been
`undergoing treatment.
`
`Who gets breast cancer?
`
`$83»:
`
`. Excluding cancers of the skin, breast cancer is the most
`common cancer among US women, accounting for 29% of
`newly diagnosed cancers.
`
`. Men are generally at low risk for developing breast cancer;
`however, they should report any change in their breasts
`to a physician.
`
`age
`
`Breast cancer incidence and death rates generally increase
`with age (Figure 1, page 2). Seventy—nine percent of new cases
`and 88% of breast cancer deaths occurred in women 50 years
`of age and older.
`The decrease in incidence rates that occurs in women 80
`
`years of age and older may reflect lower rates of screening,
`the detection of cancers by mammography before 80 years of
`age, and/or incomplete detection.
`
`During 2006—2010, the median age at the time of breast
`cancer diagnosis was 61.14 This means that half of women
`who developed breast cancer were 61 years of age or younger
`at the time of diagnosis.
`
`A woman living in the US has a 12.3%, or a 1 in 8, lifetime
`risk of being diagnosed with breast cancer. In the 19705,
`the lifetime risk of being diagnosed with breast cancer was
`
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`Non-Hispanic Whites
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`Rate per 100,000
`
`19.9 - 21.3
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`21.4 - 22.2
`a. 22.3 — 229
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`E 23.0- 262
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`Rate per 100,000
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`1907 - 26.9
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`27.0 - 29.9
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`5? 30.0 - 32.9
`E! 33.0 ~ 35.4
`insufficient data
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`
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`
`*Per 100,000 and age adjusted to the 2000 US standard population.
`Note: Statistic not displayed for states with fewer than 25 deaths. Death rates for whites in DC, ND, and SC are not exclusive of Hispanic origin due to unreliable ethnicity data.
`Source: National Center for Health Statistics, Centers for Disease Control and Prevention, as provided by the Surveillance, Epidemiology, and End Results Program,
`
`National Cancer Institute.
`
`American Cancer Society, Surveillance and Health Services Research, 2013
`
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`1984
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`1987
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`1990
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`1993
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`1996
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`2002
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`1996
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`1999
`
`2002
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`2005
`
`20082010
`
`*Rates are age adjusted to the 2000 US standard population within each age group.
`Source: Surveillance, Epidemiology, and End Results (SEER) Program, SEER 9 Registries, National Cancer Institute.
`American Cancer Society, Surveillance and Health Services Research, 2013
`
`figure 1 Eaciziéame gates” at in 8%; amt invasive $aamafa Emmi Came? fey ”9’31? adjasted ft}: {323.9% 3.333;;
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`400 _
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`Are there geographic differences in breast
`cancer rates?
`
`Table 2 (page 3) shows breast cancer incidence and death rates
`per 100,000 women for non—Hispanic white, African American,
`and Hispanic women by state. Breast cancer incidence rates
`range from 109.6 (cases per 100,000 women) in Arkansas to 160.5
`in the District of Columbia among non—Hispanic white women;
`83.4 in New Mexico to 147.5 in Alaska among African American
`women; and 35.1 in Mississippi to 119.6 in Connecticut among
`Hispanic women. Incidence rates reflect disease occurrence, as
`well as how completely the population is screened.
`
`Despite higher incidence rates, breast cancer death rates are
`generally lower among non-Hispanic white women compared to
`African American women. Death rates reflect both cancer inci-
`
`dence rates and survival. Breast cancer death rates range from
`19.9 in Hawaii to 26.2 in NewJersey among noneHispanic white
`women and from 19.7 in Rhode Island to 35.4 in Tennessee
`
`among African American women. Breast cancer death rates are
`lowest for Hispanic women and range from 6.0 in Georgia to 19.3
`in Nebraska.
`
`Breast cancer mortality rates among non-Hispanic white
`women tend to be highest in the West, Midwest, and Mid—Atlan-
`tic regions of the US. Among African American women, the
`highest death rates are found in some of the Southern and Mid—
`western states (Figure 3, page 5).
`
`How has the occurrence of breast cancer
`
`changed over time?
`
`mama trerzz’és -- women
`
`Figure 4 presents trends for in situ and invasive breast cancer
`incidence rates since 1975, when population-based cancer regis-
`tration began in the nine oldest cancer registries.
`
`331 site iataast came?
`
`Incidence rates of in situ breast cancer rose rapidly during the
`1980s and 19905 (Figure 4a), largely because of increases in
`mammography screening. The increase in incidence was greater
`in women 50 years of age and older than in those younger than
`50. Since 1999, incidence rates of in situ breast cancer have stabi—
`
`lized among women 50 and older, but continue to increase in
`younger women (1.9% per year from 1998 to 2010). The stabiliza-
`tion in incidence among women 50 years of age and older likely
`reflects trends in mammography screening rates, which peaked
`in 2000 and then stabilized at a slightly lower rate.16 It may also
`reflect a reduced pool of prevalent cases as a result of wide—
`spread screening.
`
`lnvasive breast cancer
`
`Much of the historic increase in breast cancer incidence reflects
`
`changes in reproductive patterns, such as delayed childbearing
`and having fewer children, which are recognized risk factors for
`breast cancer. However, between 1980 and 1987, breast cancer
`
`incidence rates increased rapidly, due largely to greater use of
`
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`IMMUNOGEN 2205. pg. 8
`Phigenix v. Immunogen
`|PR2014—00676
`
`IMMUNOGEN 2205, pg. 8
`Phigenix v. Immunogen
`IPR2014-00676
`
`

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`
`1975 1977 1979 1981 198: 1985 1907 1989 1991 1993 1995 1997 19992001 2003 20052007
`Year
`
`2010
`
`*Rates are age adjusted to the 2000 US standard population.
`Source: Surveillance, Epidemiology, and End Results (SEER) Program, National
`Cancer Institute. Data for whites and African Americans are from the 9 SEER
`registries and were adjusted for reporting delay. Data for other races/ethnicities
`are Z—year moving averages from the 13 SEER registries. For Hispanics, incidence
`data do not include cases from the Alaska Native Registry. Incidence data for
`American Indians/Alaska Natives are based on Contract Health Service Delivery
`Area (CHSDA) counties.
`
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`1975 1977 1979 1981 1983 1985 1937 1989 1991 1993 1995 199.‘ 1999 2001 2003 2005 2007
`2010
`Year
`
`*Rates are age adjusted to the 2000 US standard population.
`Source: National Center for Health Statistics, Centers for Disease Control and
`Prevention, as provided by the Surveillance, Epidemiology, and End Results
`Program, National Cancer Institute. Rates for American Indians/Alaska Natives
`are based on data from the Contract Health Service Delivery Area (CHSDA)
`counties. For Hispanics, mortality rates do not include data from Connecticut,
`Maine, Maryland, Minnesota, New Hampshire, New York, North Dakota,
`Oklahoma, Vermont, and the District of Columbia.
`American Cancer Society, Surveillance and Health Services Research, 2013
`
`
`
`{19329212 a
`
`IMMUNOGEN 2205, pg. 9
`Phigenix v. Immunogen
`|PR2014—00676
`
`mammography screening, which can detect breast cancers too
`small to be felt. The widespread uptake of mammography
`screening inflated the incidence rate because cancers were
`being diagnosed 1 to 3 years earlier than they would have in the
`absence of screening. Rates stabilized in the early 1990s, fol—
`lowed by a slower increase during the latter half of the decade.
`This trend may reflect further increases in the prevalence of
`mammography screening, as well as rising rates of obesity and
`the use of menopausal hormones, both of which increase breast
`cancer risk. Between 2002 and 2003, breast cancer rates dropped
`sharply (nearly 7%), likely due to the decreased use ofmenopausal
`hormones following the 2002 publication of the Women’s Health
`Initiative randomized trial resultsfm The decline occurred pri—
`marily in white women, in women ages 50 and older, and for ER+
`disease.”19 This trend may also reflect declines in mammography
`screening. The percentage ofwomen 40 years ofage and older who
`reported having a mammogram within the past 2 years peaked
`in 2000, declined slightly, and has since stabilized.16 Similar
`reversals in breast cancer trends have been observed interna—
`
`tionally, as well.”24 Since 2004, overall breast cancer incidence
`rates have remained relatively stable.14
`
`Race/Ethnicity: Figure 5a presents trends in invasive female
`breast cancer incidence rates by race and ethnicity. Incidence
`data are available for white and African American women since
`1975 and for women of other races and ethnicities since 1992.
`
`During 2006—2010 (the most recent 5 years of data available),
`overall breast cancer incidence rates increased slightly (0.2% per
`year) among African American women, decreased by 0.6% per
`year in Hispanic women, and did not change significantly among
`whites, Asians/Pacific Islanders (API), or American Indians/
`Alaska Natives (AI/AN).l4 Notably, rates for white and African
`American women are converging. Please note that rates for
`white and African American women were adjusted for delays in
`case reporting; delay—adjusted rates are not available for other
`races/ethnicities, resulting in slightly underestimated rates,
`particularly for the most recent data years. Also, rates for Ameri—
`can Indians/Alaska Natives are based on limited geographic
`areas with high—quality data.
`
`Age: Trends for invasive breast cancer by age at diagnosis are
`shown in Figure 4b. Overall breast cancer incidence rates have
`been relatively stable for both women under the age of 50 and
`those ages 50 and older during the most recent time period
`(2006—2010). However, trends by age at diagnosis vary by race
`and ethnicity. Although the overall incidence trends for White
`and API women were stable, rates increased slightly during
`2006-2010 for white and API women younger than 50 by 0.1% and
`0.8% per year, respectively.14 Among women 50 years of age and
`older, incidence rates decreased slightly in Hispanics (0.7% per
`year) and increased slightly (0.3% per year) in African Americans.14
`Incidence rates were stable for white, Asian/Pacific Islander,
`
`and American Indian/Alaska Native women 50 years of age and
`older during 2006—2010.14
`
`IMMUNOGEN 2205, pg. 9
`Phigenix v. Immunogen
`IPR2014-00676
`
`

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`1978
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`1982
`1984
`1986
`1988
`1990
`1992
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`2000
`2002
`2004
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`2008
`2010
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`*Rates are two-year moving averages and age adjusted to the 2000 US standard popula
`Source: Surveillance, Epidemiology, and End Results (SEER) Program, 9 SEER Registries, National Cancer Institute.
`American Cancer Society, Surveillance and Health Services Research, 2013
`
`
`
`Tumor size: Incidence rates of breast cancer by tumor size
`differ between white and African American women. African
`
`American women are less likely to be diagnosed with smaller
`tumors (52.0 cm) and more likely to be diagnosed with larger
`tumors (> 5.0 cm) than white women.
`
`Figure 6a describes trends in incidence rates by tumor size and
`race. For smaller tumors (3 2.0 cm), incidence rates decreased by
`1.1% per year during 2006—2010 among white women, but were
`stable among African American women. The incidence rate for
`tumors 2.1-5.0 cm increased during 2006—2010 for both white
`and African American women, by 1.1% and 0.5% per year, respec—
`
`
`
` 5:3 81mg? C.
`
`IMMUNOGEN 2205, pg. 10
`Phigenix v. Immunogen
`|PR2014—00676
`
`IMMUNOGEN 2205, pg. 10
`Phigenix v. Immunogen
`IPR2014-00676
`
`

`

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