Press Release - The North American Association of Central Cancer

EMBARGOED FOR RELEASE
Monday, March 30, 2015
4 p.m. EDT
CONTACT:
NCI Media Relations Branch: (301) 4966641 or ncipressofficers@mail.nih.gov
NAACCR: (217) 698-0800 or
bkohler@naaccr.org
ACS Press Office:
david.sampson@cancer.org
CDC Press Office: (404) 639-3286 or
media@cdc.gov
New analysis of breast cancer subtypes could lead to better risk stratification;
Annual Report to the Nation shows that mortality and incidence for most cancers
continue to decline
For the first time, researchers have used national data to determine the incidence of the
four major molecular subtypes of breast cancer by age, race/ethnicity, poverty level, and
several other factors. These four subtypes respond differently to treatment and have
different survival rates. The new data will help researchers more accurately stratify
breast cancer by clinically relevant degrees of risk and potentially have an impact on
breast cancer treatment. Moreover, armed with this information, women will be able to
better understand the implications for their health based on their breast cancer subtype.
These findings, along with statistical analyses of the most common types of cancer, were
reported today in JNCI. “The Annual Report to the Nation on the Status of Cancer, 19752011” showed continuing declines in cancer deaths for both men and women, for
children, and for nearly all major cancer sites. The report was co-authored by experts
from the North American Association of Central Cancer Registries (NAACCR), the
American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC),
and the National Cancer Institute (NCI) at the National Institutes of Health.
Breast cancer subtypes have major implications for determining treatment and may hold
important clues to the origins of breast cancer. There are four molecular subtypes, which
can be approximated by their hormone receptor (HR) status and expression of the HER2
gene: Luminal A (HR+/HER2-), Luminal B (HR+/HER2+), HER2-enriched (HR/HER2+), and triple negative (HR-/HER2-). These subtypes are now being recorded by
1 cancer registries across the nation, giving statisticians the ability for the first time to
comprehensively examine breast cancer rates based on clinically meaningful subtypes.
The new report suggests that some of the differences in rates of breast cancer incidence
and mortality across racial and ethnic groups are related to differences in the incidence of
different subtypes. Geographic variation in rates that the authors observed were based on
multiple factors, including underlying demographic patterns, regional cultures and
associated behaviors, as well as access to care.
The researchers found unique racial/ethnic group-specific patterns by age, poverty level,
geography, and by specific tumor characteristics. Rates of HR+/HER2- breast cancer, the
least aggressive subtype, were highest among non-Hispanic whites, aligning with
previously reported findings. Rates of HR+/HER2- breast cancer decreased with
increasing levels of poverty for every racial and ethnic group. Also consistent with prior
studies, non-Hispanic blacks had higher incidence rates of the most aggressive breast
cancer subtype, triple negative, than other racial/ethnic groups.
Non-Hispanic blacks also had the highest rates of late-stage disease and of
poorly/undifferentiated pathology among all the subtypes. All of these factors are
associated with lower survival and correspond with blacks having the highest rates of
breast cancer deaths.
“In addition to confirming the largely encouraging trends in cancer mortality rates for
men, women, and children, this year’s report assesses breast cancer as four molecularly
defined subtypes, not as a single disease. This is a welcome step, depending on
medically important information that already guides therapeutic strategies for these
subtypes,” said NCI Director Harold Varmus, M.D. “Further, it is a harbinger of the
more rigorous classification of cancers based on their molecular features that is now
being aggressively pursued under the President’s Precision Medicine Initiative. The new
diagnostic categories now being defined will increasingly support our ability to prevent
and treat breast and many other kinds of cancer, as well as monitor their incidence and
outcomes more rigorously over time.”
The report also details trends in incidence and death rates of many major cancers and all
cancers combined. Overall cancer incidence -- new cases of cancer -- continued to
decrease in men, remained stable in women, and increased in children. The authors also
found that there has been a relatively consistent decline in overall cancer mortality rates
since the early 1990s, with rates from 2002 to 2011 decreasing by about 1.8 percent per
year among males and by 1.4 percent per year among females. Among children up to 19
years old, mortality rates have continued to decrease since 1975, with the exception of the
period between 1998 and 2003.
2 “The continued decline in cancer death rates among men, women, and children is
encouraging, and it reflects progress we are making in cancer prevention, early detection,
and treatment,” said CDC Director Tom Frieden, M.D. “However, the continuing high
burden of preventable cancer, and disparities in death rates among races and ethnicities,
show that we still have a long way to go.” For the most recent reporting period, the rate of decline in lung cancer incidence and
mortality has accelerated in both men and women, most likely reflecting sustained public
health efforts to decrease smoking rates. Colorectal cancer incidence and mortality
among both men and women, and prostate cancer incidence and mortality in men,
continue the downward trends seen in previous years.
“The drop in incidence in lung and colorectal cancers shows the lifesaving impact of
prevention,” said John R Seffrin, Ph.D., American Cancer Society Chief Executive
Officer. “But we have a long way to go, not only in these two cancers but in the many
other cancers where the trend has not been so positive.”
Overall cancer incidence rates decreased by 0.5 percent per year from 2002 to 2011.
Among men, incidence rates decreased an average of 1.8 percent per year from 2007 to
2011; incidence rates were stable in women from 1998 to 2011. Among children up to 19
years of age, incidence rates have increased by 0.8 percent per year over the past decade,
continuing a trend dating from 1992 whose cause remains uncertain.
The report also noted some trends that require greater evaluation:
 Incidence rates of thyroid and kidney cancers are increasing among both men and
women. Increases in rates for new cases of thyroid and kidney cancers may be
due to several factors, but no increase in mortality has been noted for these
diseases.
 Incidence and mortality rates of liver cancer are increasing among both men and
women. These increases may reflect, in part, increasing rates of hepatitis C
and/or behavioral risk factors, such as alcohol abuse, for which there are
opportunities for intervention
 Unlike the declines in incidence of other tobacco-related cancers, incidence rates
are increasing for oral/oropharyngeal cancers overall among white men. This may
be associated with increased HPV-associated oropharyngeal cancers, despite a
decline in those oral cancers that are more closely associated with tobacco use.
 Incidence and mortality rates are increasing for uterine cancer among white,
black, and Asian Pacific Islander women, with the largest increase seen in black
women. The cause of these increases is unknown.
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Reference: Kohler B.A, et al. Annual Report to the Nation on the Status of Cancer, 1975
-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and
State. JNCI. Online March 30, 2015. DOI: 10.1093/jnci.j/djv048.
To view a Q&A on the Report go to
http://www.cancer.gov/newscenter/newsfromnci/2015/ReportNationMarch2015QandA,
For a Spanish translation of the press release go to
http://www.cancer.gov/espanol/noticias/informeNacionMarch2015.
CDC’s Division of Cancer Prevention and Control: http://www.cdc.gov/cancer ; National
Program of Cancer Registries: http://www.cdc.gov/cancer/npcr; and the National Vital
Statistics System: http://www.cdc.gov/nchs/nvss.htm.
ACS: http://www.cancer.org.
NCI: http://www.cancer.gov and SEER (NCI’s Surveillance, Epidemiology, and End
Results program): http://www.seer.cancer.gov.
NAACCR: http://www.naaccr.org The North American Association of Central Cancer
Registries, Inc. is a professional organization that develops and promotes uniform data
standards for cancer registration; provides education and training; certifies populationbased registries; aggregates and publishes data from central cancer registries; and
promotes the use of cancer surveillance data and systems for cancer control and
epidemiologic research, public health programs, and patient care to reduce the burden of
cancer in North America.
CDC works 24/7 saving lives, protecting people from health threats, and saving money
through prevention. Whether these threats are global or domestic, chronic or acute,
curable or preventable, natural disaster or deliberate attack, CDC is the nation’s health
protection agency.
The American Cancer Society saves lives and creates a world with less cancer and more
birthdays by helping you stay well, helping you get well, by finding cures and fighting
back. As the nation’s largest non-governmental investor in cancer research, contributing
about $3.4 billion, we turn what we know about cancer into what we do. To learn more
about us or to get help, call 1-800-227-2345 or visit www.cancer.org
The National Cancer Institute leads the National Cancer Program and the NIH’s efforts to
dramatically reduce the prevalence of cancer and improve the lives of cancer patients and
their families, through research into prevention and cancer biology, the development of
new interventions, and the training and mentoring of new researchers. For more
information about cancer, please visit the NCI Web site at http://www.cancer.gov or call
NCI's Cancer Information Service at 1-800-4-CANCER.
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