Abstract
Background: Internationally, California has some of the highest breast cancer rates; these rates also show substantial regional variations within the state. This study describes geographic breast cancer incidence patterns within California and evaluates the degree to which socioeconomic status (SES) and urbanization explain the regional variability.
Methods: Invasive breast cancer cases in women ≥20 year of age were identified from the California Cancer Registry, for 1988–1997, then assigned to one of three regions (San Francisco Bay Area, Southern Coastal Area and the rest of California), based on residence at diagnosis. Neighborhood SES and urbanization were derived from U.S. Census data. Rate ratios (RR) and 95% confidence intervals (CI) were computed using Poisson regression. Analyses were conducted for all invasive breast cancer cases (n=176,302) and by selected histologic subtypes: ductal (n=121,619); lobular (n=13,410); mixed ductal and lobular (n=9744).
Results: Compared to block groups with the lowest quartile of SES, rates were highest in block groups with high SES. Rates also were higher in suburban and city areas than in small town/rural areas. Compared to the rest of California, age- and race-adjusted rates for all breast cancer were approximately 20% higher in the San Francisco Bay Area and 10% higher in the Southern Coastal Area. After adjusting for SES and urbanization the rate ratios were reduced to near unity (RR=1.06, 95% CI: 1.03–1.09 for San Francisco Bay Area; RR=1.02, 95% CI: 0.99–1.04 for Southern Coastal Area). Rates ratios for ductal carcinomas mirrored those for all cases. For lobular cases, rate ratios remained elevated after adjustment for age, race/ethnicity, neighborhood SES and urbanization (RR=1.18, 95% CI: 1.11–1.27 for San Francisco Bay Area; RR=1.10, 95% CI: 1.04–1.17 for Southern Coastal Area). For the subset of cases with mixed ductal and lobular histologies, the rate ratio for the San Francisco Bay Area was no longer elevated after adjusting for age, race/ethnicity, SES and urbanization (RR=0.92, 95% CI: 0.84–1.01); the adjusted rate ratio for the Southern Coastal Area, however, remained elevated (RR=1.22, 95% CI: 1.12–1.32).
Conclusions: Regional differences in neighborhood SES and urbanization appear to largely explain regional rate differences in California for all breast cancers and ductal carcinomas but do not fully explain geographic patterns of breast cancer with a lobular component.
Similar content being viewed by others
References
Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J, eds (1997) Cancer Incidence in Five Continents. Vol. VII. Lyon, France: International Agency for Research on Cancer (IARC), 1997 (IARC Scientific Publications No. 143)
DM. Parkin (2001) ArticleTitleGlobal cancer statistics in the year 2000 Lancet Oncol. 2 533–543 Occurrence Handle10.1016/S1470-2045(01)00486-7 Occurrence Handle1:STN:280:DC%2BD387ntlCrtw%3D%3D Occurrence Handle11905707
National Cancer Institute (2004) Surveillance, Epidemiology & End Results (SEER) Homepage [Web Page]. Available at http://www.seer.cancer.gov/ (Accessed 11 May 2004)
CI Li BO Anderson P Porter SK Holt JR Daling RE. Moe (2000) ArticleTitleChanging incidence rate of invasive lobular breast carcinoma among older women Cancer. 88 2561–2569 Occurrence Handle10.1002/1097-0142(20000601)88:11<2561::AID-CNCR19>3.0.CO;2-X Occurrence Handle1:STN:280:DC%2BD3cvisFyrtg%3D%3D Occurrence Handle10861434
CI Li BO Anderson JR Daling RE. Moe (2003) ArticleTitleTrends in incidence rates of invasive lobular and ductal breast carcinoma JAMA. 289 1421–1424 Occurrence Handle10.1001/jama.289.11.1421 Occurrence Handle12636465
MP Madigan RG Ziegler J Benichou C Byrne RN. Hoover (1995) ArticleTitleProportion of breast cancer cases in the United States explained by well-established risk factors J Natl Cancer Inst. 87 1681–1685 Occurrence Handle1:STN:280:DyaK28%2Flt1elsg%3D%3D Occurrence Handle7473816
CI Perkins (1995) Cancer incidence and mortality in California by detailed race/ethnicity, 1988–1992 California Cancer Registry Sacramento CA
C Morris S Kwong (2004) Breast Cancer in California 2003 Department of Health Services, Cancer Surveillance Section Sacramento, CA, USA: California
WJ Blot JF Fraumeni SuffixJr BJ. Stone (1977) ArticleTitleGeographic patterns of breast cancer in the United States J Natl Cancer Inst. 59 1407–1411 Occurrence Handle1:STN:280:DyaE1c%2FgvVSltA%3D%3D Occurrence Handle909100
SR Sturgeon C Schairer M Gail M McAdams LA Brinton RN. Hoover (1995) ArticleTitleGeographic variation in mortality from breast cancer among white women in the United States J Natl Cancer Inst. 87 1846–1853 Occurrence Handle1:STN:280:DyaK287gtFOntA%3D%3D Occurrence Handle7494228
FC Garland CF Garland ED Gorham JF. Young (1990) ArticleTitleGeographic variation in breast cancer mortality in the United States: a hypothesis involving exposure to solar radiation Prev Med. 19 614–622 Occurrence Handle10.1016/0091-7435(90)90058-R Occurrence Handle1:STN:280:DyaK3M%2FovVCrtg%3D%3D Occurrence Handle2263572
JS Goodwin JL Freeman D Freeman AB. Nattinger (1998) ArticleTitleGeographic variations in breast cancer mortality: do higher rates imply elevated incidence or poorer survival? Am J Public Health. 88 458–460 Occurrence Handle1:STN:280:DyaK1c7nvFCrtQ%3D%3D Occurrence Handle9518983 Occurrence Handle10.2105/AJPH.88.3.458
F Laden D Spiegelman etal. Neas LM. (1997) ArticleTitleGeographic variation in breast cancer incidence rates in a cohort of U.S. women J Natl Cancer Inst. 89 1373–1378 Occurrence Handle10.1093/jnci/89.18.1373 Occurrence Handle1:STN:280:DyaK2svlt1aqtg%3D%3D Occurrence Handle9308708
AW Prehn DW. West (1998) ArticleTitleEvaluating local differences in breast cancer incidence rates: a census- based methodology (United States) Cancer Causes Control. 9 511–517 Occurrence Handle10.1023/A:1008809819218 Occurrence Handle1:STN:280:DyaK1M7jtFCitw%3D%3D Occurrence Handle9934716
AS Robbins S Brescianini JL. Kelsey (1997) ArticleTitleRegional differences in known risk factors and the higher incidence of breast cancer in San Francisco J Natl Cancer Inst. 89 960–965 Occurrence Handle10.1093/jnci/89.13.960 Occurrence Handle1:STN:280:DyaK2szlslentQ%3D%3D Occurrence Handle9214676
Reynolds P, Hurley S, Goldberg D etal. Regional Variations in breast cancer among California teachers, Epidemiology in press
R. Doll (1991) ArticleTitleUrban and rural factors in the aetiology of cancer Int J Cancer. 47 803–810 Occurrence Handle1:STN:280:DyaK3M7osVyqsA%3D%3D Occurrence Handle2010224
MC Mahoney DS LaBrie PC Nasca PE Wolfgang WS. Burnett (1990) ArticleTitlePopulation density and cancer mortality differentials in New York State, 1978–1982 Int J Epidemiol. 19 483–490 Occurrence Handle1:STN:280:DyaK3M%2FosF2rsA%3D%3D Occurrence Handle2262237
K Yost C Perkins R Cohen C Morris W. Wright (2001) ArticleTitleSocioeconomic status and breast cancer incidence in California for different race/ethnic groups Cancer Causes Control. 12 703–711 Occurrence Handle10.1023/A:1011240019516 Occurrence Handle1:STN:280:DC%2BD3MrhsVantw%3D%3D Occurrence Handle11562110
NH. Gordon (2003) ArticleTitleSocioeconomic factors and breast cancer in black and white Americans Cancer Metastasis Rev. 22 55–65 Occurrence Handle10.1023/A:1022212018158 Occurrence Handle1:CAS:528:DC%2BD3sXpt1WktQ%3D%3D Occurrence Handle12716037
KE Heck ER. Pamuk (1997) ArticleTitleExplaining the relation between education and postmenopausal breast cancer Am J Epidemiol. 145 366–372 Occurrence Handle1:STN:280:DyaK2s7ovVKrtQ%3D%3D Occurrence Handle9054241
L. Teppo (1984) ArticleTitleCancer incidence by living area, social class and occupation Scand J Work Environ Health. 10 361–366 Occurrence Handle1:STN:280:DyaL2M3hvVKgsg%3D%3D Occurrence Handle6535240
FD Gilliland WC Hunt etal. Baumgartner KB (1998) ArticleTitleReproductive risk factors for breast cancer in Hispanic and non-Hispanic white women: the New Mexico Women’s Health Study Am J Epidemiol. 148 683–692 Occurrence Handle1:STN:280:DyaK1cvkvFKhtg%3D%3D Occurrence Handle9778175 Occurrence Handle10.1093/aje/148.7.683
F Barbone R Filiberti etal. Franceschi S (1996) ArticleTitleSocioeconomic status, migration and the risk of breast cancer in Italy Int J Epidemiol. 25 479–487 Occurrence Handle1:STN:280:DyaK28zisVymtA%3D%3D Occurrence Handle8671547
CL Carter DY Jones A Schatzkin LA. Brinton (1989) ArticleTitleA prospective study of reproductive, familial and socioeconomic risk factors for breast cancer using NHANES I data Public Health Rep. 104 45–50 Occurrence Handle1:STN:280:DyaL1M7mtFSqtg%3D%3D Occurrence Handle2493661
Hall SA, Rockhill B. (2002). Race, poverty, affluence, and breast cancer. Am J Public Health. 92: 1559; author reply 1560
SA Robert I Strombom etal. Trentham-Dietz A (2004) ArticleTitleSocioeconomic risk factors for breast cancer: distinguishing individual- and community-level effects Epidemiology. 15 442–450 Occurrence Handle10.1097/01.ede.0000129512.61698.03 Occurrence Handle15232405
A Tavani C Braga C La Vecchia E Negri A Russo S. Franceschi (1997) ArticleTitleAttributable risks for breast cancer in Italy: education, family history and reproductive and hormonal factors Int J Cancer. 70 159–163 Occurrence Handle10.1002/(SICI)1097-0215(19970117)70:2<159::AID-IJC4>3.0.CO;2-W Occurrence Handle1:STN:280:DyaK2s7mt1WltQ%3D%3D Occurrence Handle9009154
Haenszel W, Marcus SC, Zimmerer EG. (1956). Cancer morbidity in urban and rural Iowa. Public Health Monogr. 1–85
J Pawlega R. Wallace (1980) ArticleTitleNutrition and age at first birth in breast-cancer risk Br J Cancer. 41 941–945 Occurrence Handle1:STN:280:DyaL3M%2FjvFCjsQ%3D%3D Occurrence Handle7426318
PC Nasca WS Burnett P Greenwald K Brennan P Wolfgang K. Carlton (1980) ArticleTitlePopulation density as an indicator of urban–rural differences in cancer incidence, upstate New York, 1968–1972 Am J Epidemiol. 112 362–375 Occurrence Handle1:STN:280:DyaL3M%2Fjs1Omsw%3D%3D Occurrence Handle7424884
PC Nasca MC Mahoney PE. Wolfgang (1992) ArticleTitlePopulation density and cancer incidence differentials in New York State, 1978–1982 Cancer Causes Control. 3 7–15 Occurrence Handle10.1007/BF00051906 Occurrence Handle1:STN:280:DyaK387mt12lug%3D%3D Occurrence Handle1536917
R Sierra DM Parkin GM. Leiva (1989) ArticleTitleCancer in Costa Rica Cancer Res. 49 717–724 Occurrence Handle1:STN:280:DyaL1M%2FovFKnsg%3D%3D Occurrence Handle2910491
HL Howe JE Keller M. Lehnherr (1993) ArticleTitleRelation between population density and cancer incidence, Illinois, 1986–1990 Am J Epidemiol. 138 29–36 Occurrence Handle1:STN:280:DyaK3szisFGksQ%3D%3D Occurrence Handle8333424
Z Valerianova C Gill SW Duffy SE. Danon (1994) ArticleTitleTrends in incidence of various cancers in Bulgaria, 1981–1990 Int J Epidemiol. 23 1117–1126 Occurrence Handle1:STN:280:DyaK2M3jvVSltw%3D%3D Occurrence Handle7721511
A Vassallo E Stefani Particlede A Ronco E. Barrios (1994) ArticleTitleUrbanization gradients and cancer mortality in Uruguay, 1988–1992 Int J Cancer. 59 345–350 Occurrence Handle1:STN:280:DyaK2M%2Fht1yqsg%3D%3D Occurrence Handle7927939
CC Benz CA Clarke II. Moore DH (2003) ArticleTitleGeographic excess of estrogen receptor-positive breast cancer Cancer Epidemiol Biomarkers Prev. 12 1523–1527 Occurrence Handle14693747
H Stalsberg DB Thomas EA. Noonan (1989) ArticleTitleHistologic types of breast carcinoma in relation to international variation and breast cancer risk factors WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Int J Cancer. 44 399–409 Occurrence Handle1:STN:280:DyaL1MznvFCgtw%3D%3D
J. MacLean (2004) Breast Cancer in California: A Closer Look Oakland CA
C Percy V Van Holten C Muir (Eds) (1990) International Classification of Diseases for Oncology EditionNumber2 World Health Organization Geneva, Switzerland
SL Kwong CI Perkins CR Morris R Cohen M Allen WE Wright (2001) Cancer in California: 1988–1999 California Department of Health Services, Cancer Surveillance Section Sacramento, CA, USA
SE Hurley TM Saunders R Nivas A Hertz P. Reynolds (2003) ArticleTitlePost office box addresses: a challenge for geographic information system-based studies Epidemiology. 14 386–391 Occurrence Handle12843760
United States Bureau of the Census (2000) Females 20+ for mutually exclusive race/Hispanic groups at block group level, 1990: unpublished special tabluation of 100% microdata of 7 groups; 2000: Census 2000 Summary File 1, Tables PCT12H-O (8 groups) [data file – unpublished data]. Washington DC, USA: United States Bureau of the Census
U.S. Centers for Disease Control, National Center for Health Statistics (2004) U.S. Census Populations with Bridged Race Categories [Web Page]. Available at http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm, (Accessed 11 August 2004)
United States Bureau of the Census (1992) Census of Population and Housing, 1990: Summary Tape File 3 (California) [data file]. Washington DC, USA: United States Bureau of the Census
United States Bureau of the Census (30 April 2002) Census 2000 Urban and Rural Classification [Web Page]. Available at http://www.census.gov/geo/www/ua/ua_2k.html (Accessed 22 January 2003)
F. Waard Particlede (1998) ArticleTitleRisk factors for breast cancer at various ages Eur J Cancer Prev. 7 IssueID(Suppl 1 S13–S15 Occurrence Handle10866030
National Cancer Institute (2003) Menopausal Hormone Use: Questions and Answers [Web Page]. Available at http://www.cancer.gov/newscenter/estrogenplus (Accessed 24 June 2003)
InstitutionalAuthorNameSAS Institute, Inc. (2001) SAS 8.01, 8.01 [computer program] SAS Institute, Inc Cary, NC, USA
DW Hosmer S Lemeshow (1989) Applied Logistic Regression John Wiley & Sons New York, NY, USA
InstitutionalAuthorNameSAS Institute, Inc. (1999) SAS/STAT User’s Guide EditionNumber8 SAS Institute, Inc. Cary, NC
DN. Barron (1992) ArticleTitleThe analysis of count data: overdispersion and autocorrelation Socio. Methodol. 22 179–220
P McCullagh JA Nelder (1989) Generalized linear models. Monographs on Statistics and Applied Probability EditionNumber2 Chapman and Hall London
L Bernstein M Allen etal. Anton-Culver H (2002) ArticleTitleHigh breast cancer incidence rates among California teachers: results from the California Teachers Study (United States) Cancer Causes Control. 13 625–635 Occurrence Handle10.1023/A:1019552126105 Occurrence Handle12296510
Clarke CA, Glaser SL, West DW etal. (2002). Breast cancer incidence and mortality trends in an affluent population: Marin County, California, USA, 1990–1999. Breast Cancer Res 4: R13
Perkins C (1996) Laterality, detailed Primary site and histology of female breast cancer, 1988–1992. In: Morris CR, Wright WE, eds. Breast Cancer in California. Sacramento, CA, USA: California Department of Health Services, Cancer Surveillance Section
HM Verkooijen G Fioretta etal. Vlastos G (2003) ArticleTitleImportant increase of invasive lobular breast cancer incidence in Geneva Switzerland Int J Cancer. 104 778–781 Occurrence Handle10.1002/ijc.11032 Occurrence Handle1:CAS:528:DC%2BD3sXjtVWqtrY%3D Occurrence Handle12640687
CL Chen NS Weiss P Newcomb W Barlow E. White (2002) ArticleTitleHormone replacement therapy in relation to breast cancer JAMA. 287 734–741 Occurrence Handle10.1001/jama.287.6.734 Occurrence Handle1:CAS:528:DC%2BD38Xht1Kktrg%3D Occurrence Handle11851540
CI Li KE Malone PL Porter NS Weiss MT Tang JR. Daling (2003) ArticleTitleReproductive and anthropometric factors in relation to the risk of lobular and ductal breast carcinoma among women 65–79 years of age Int J Cancer. 107 647–651 Occurrence Handle10.1002/ijc.11465 Occurrence Handle1:CAS:528:DC%2BD3sXoslCjs74%3D Occurrence Handle14520705
H Stalsberg DB. Thomas (1993) ArticleTitleAge distribution of histologic types of breast carcinoma Int J Cancer. 54 1–7 Occurrence Handle1:STN:280:DyaK3s3jvFeltw%3D%3D Occurrence Handle8478135
CI Li KE Malone PL Porter NS Weiss MT Tang JR. Daling (2003) ArticleTitleThe relationship between alcohol use and risk of breast cancer by histology and hormone receptor status among women 65–79 years of age Cancer Epidemiol Biomarkers Prev. 12 1061–1066 Occurrence Handle1:CAS:528:DC%2BD3sXosVCru7Y%3D Occurrence Handle14578143
California Department of Finance (2001) Sacramento, CA, USA: California Department of Finance
N. Krieger (1990) ArticleTitleSocial class and the black/white crossover in the age-specific incidence of breast cancer: a study linking census-derived data to population-based registry records Am J Epidemiol. 131 804–814 Occurrence Handle1:STN:280:DyaK3c3htVShuw%3D%3D Occurrence Handle2321624
M Stierer H Rosen R Weber H Hanak J Spona H. Tuchler (1993) ArticleTitleImmunohistochemical and biochemical measurement of estrogen and progesterone receptors in primary breast cancer Correlation of histopathology and prognostic factors. Ann Surg. 218 13–21 Occurrence Handle1:STN:280:DyaK3szhvFeitw%3D%3D
CI Li NS Weiss JL Stanford JR. Daling (2000) ArticleTitleHormone replacement therapy in relation to risk of lobular and ductal breast carcinoma in middle-aged women Cancer. 88 2570–2577 Occurrence Handle10.1002/1097-0142(20000601)88:11<2570::AID-CNCR20>3.0.CO;2-O Occurrence Handle1:CAS:528:DC%2BD3cXktFGjsLs%3D Occurrence Handle10861435
LM Newcomer PA Newcomb etal. Potter JD (2003) ArticleTitlePostmenopausal hormone therapy and risk of breast cancer by histologic type (United States) Cancer Causes Control. 14 225–233 Occurrence Handle10.1023/A:1023634907723 Occurrence Handle12814201
LM Newcomer PA Newcomb A Trentham-Dietz MP Longnecker ER. Greenberg (2003) ArticleTitleOral contraceptive use and risk of breast cancer by histologic type Int J Cancer. 106 961–964 Occurrence Handle10.1002/ijc.11307 Occurrence Handle1:CAS:528:DC%2BD3sXnsVGrtr4%3D Occurrence Handle12918077
Survey Research Group (2000) California Women’s Health Survey [Web Page]. Available at http://www.surveyresearchgroup.com/clients.asp?ID=11 (Accessed 11 May 2004)
The Regents of the University of California (2003) California Health Interview Survey [Web Page]. Available at http://www.chis. ucla.edu/main/ (Accessed 11 May 2004)
KM Brett JH. Madans (1997) ArticleTitleUse of postmenopausal hormone replacement therapy: estimates from a nationally representative cohort study Am J Epidemiol. 145 536–545 Occurrence Handle1:STN:280:DyaK2s3hslehsQ%3D%3D Occurrence Handle9063344
NL Keating PD Cleary AS Rossi AM Zaslavsky JZ. Ayanian (1999) ArticleTitleUse of hormone replacement therapy by postmenopausal women in the United States Ann Int Med. 130 545–553 Occurrence Handle1:STN:280:DyaK1M7ovVyhtQ%3D%3D Occurrence Handle10189323
A Ferrara AJ Karter LM Ackerson JY Liu JV. Selby (2001) ArticleTitleHormone replacement therapy is associated with better glycemic control in women with type 2 diabetes: the Northern California Kaiser Permanente Diabetes Registry Diabetes Care. 24 1144–1150 Occurrence Handle1:CAS:528:DC%2BD3MXlsVOrt7s%3D Occurrence Handle11423493
PA Newcomb L Titus-Ernstoff etal. Egan KM (2002) ArticleTitlePostmenopausal estrogen and progestin use in relation to breast cancer risk Cancer Epidemiol Biomarkers Prev. 11 593–600 Occurrence Handle1:CAS:528:DC%2BD38Xmt1Wks7g%3D Occurrence Handle12101105
JM Dixon TJ Anderson DL Page D Lee SW. Duffy (1982) ArticleTitleInfiltrating lobular carcinoma of the breast Histopathology. 6 149–161 Occurrence Handle1:STN:280:DyaL387ovVarsQ%3D%3D Occurrence Handle7076138
TJ Yeatman AB Cantor etal. Smith TJ (1995) ArticleTitleTumor biology of infiltrating lobular carcinoma Implications for management. Ann Surg. 222 549–559 Occurrence Handle1:STN:280:DyaK28%2FisFWhtw%3D%3D
MJ Silverstein BS Lewinsky JR Waisman et al. (1994) ArticleTitleInfiltrating lobular carcinoma Is it different from infiltrating duct carcinoma? Cancer. 73 1673–1677 Occurrence Handle1:STN:280:DyaK2c3gsl2nsw%3D%3D Occurrence Handle8156495
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reynolds, P., Hurley, S.E., Quach, AT. et al. Regional variations in breast cancer incidence among California women, 1988–1997. Cancer Causes Control 16, 139–150 (2005). https://doi.org/10.1007/s10552-004-2616-5
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10552-004-2616-5