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Race/Ethnicity and Changing US Socioeconomic Gradients in Breast Cancer Incidence: California and Massachusetts, 1978–2002 (United States)

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Abstract

Objective We tested the hypothesis that the US socioeconomic gradient in breast cancer incidence is declining, with the decline most pronounced among racial/ethnic groups with the highest incidence rates.

Methods We geocoded the invasive incident breast cancer cases for three US population-based cancer registries covering: Los Angeles County, CA (1978–1982, 1988–1992, 1998–2002; n = 68,762 cases), the San Francisco Bay Area, CA (1978–1982, 1988–1992, 1998–2002; n = 37,210 cases) and Massachusetts (1988–1992, 1998–2002; n = 48,111 cases), linked the records to census tract area-based socioeconomic measures, and, for each socioeconomic stratum, computed average annual breast cancer incidence rates for the 5-year period straddling the 1980, 1990, and 2000 census, overall and by race/ethnicity and gender.

Results Our findings indicate that the socioeconomic gradient in breast cancer incidence is: (a) relatively small (at most 1.2) and stable among US white non-Hispanic and black women; (b) sharper and generally increasing among Hispanic and Asian and Pacific Islander American women; and (c) cannot be meaningfully analyzed without considering effect modification by race/ethnicity and immigration.

Conclusion Our results indicate that secular changes in US socioeconomic gradients in breast cancer incidence exist and vary by race/ethnicity.

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Acknowledgements

We are happy to acknowledge the participation of our contributing participating investigators, who facilitated obtaining access to the data for the project and also gave valuable input as members of our study advisory board: (a) Los Angeles Cancer Surveillance Program: Dennis Deapen, DrPH (director) and Lihua Liu, PhD; (b) Northern California Cancer Center: Dee West, PhD (director) and Scarlett Lin Gomez; (c) Massachusetts Cancer Registry: Susan Gershman, MPH, PhD, CTR (director), plus also the valuable input from Joel Schwartz, PhD (Harvard School of Public Health).

We likewise acknowledge and thank the following members of our study advisory board and the cancer registries for their input and assistance: (a) Study advisory board members: Leslie Bernstein, PhD (Los Angeles Cancer Surveillance Program); Bruce Cohen, PhD (Massachusetts Department of Public Health); Carolina Hinestrosa (National Breast Cancer Coalition); Ngina Lythcott, DrPH, MPH (Mailman School of Public Health, Columbia University; National Action Plan for Breast Cancer); Steve Melly (Harvard School of Public Health); Mary Mroszczyk (Massachusetts Cancer Registry); and (b) Cancer registry staff: Peg Balcius (Los Angeles Cancer Surveillance Program); Annie MacMillan (Massachusetts Cancer Registry); Rita Leung and Kirsten Unger Hu (Northern California Cancer Center).

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Authors and Affiliations

  1. Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Nancy Krieger, Jarvis T. Chen, Pamela D. Waterman, David H. Rehkopf & Ruihua Yin

  2. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    Brent A. Coull

Authors
  1. Nancy Krieger
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  2. Jarvis T. Chen
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  3. Pamela D. Waterman
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  4. David H. Rehkopf
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  5. Ruihua Yin
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  6. Brent A. Coull
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Corresponding author

Correspondence to Nancy Krieger.

Additional information

Funding: This investigation was supported by a grant from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services (R01 CA095983-01). The effort involving the California cancer registry data has been funded in whole or in part with Federal funds from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, under Contract no. N01-PC-35139. The collection of cancer incidence data used in this publication was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885. The ideas and opinions expressed herein are those of the authors, and no endorsement by the State of California Department of Health Services is intended or should be inferred. Additionally, the Massachusetts data were collected as part of participation in the National Program of Cancer Registries (NPCR) of the Centers for Disease Control and Prevention (CDC).

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Krieger, N., Chen, J.T., Waterman, P.D. et al. Race/Ethnicity and Changing US Socioeconomic Gradients in Breast Cancer Incidence: California and Massachusetts, 1978–2002 (United States). Cancer Causes Control 17, 217–226 (2006). https://doi.org/10.1007/s10552-005-0408-1

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