Age-Specific Incidence of Breast Cancer Subtypes: Understanding the BlackWhite Crossover

Background Breast cancer incidence is higher among black women than white women before age 40 years, but higher among white women than black women after age 40 years (blackwhite crossover). We used newly available population-based data to examine whether the age-specific incidences of breast cancer subtypes vary by race and ethnicity. Methods We classified 91908 invasive breast cancers diagnosed in California between January 1, 2006, and December 31, 2009, by subtype based on tumor expression of estrogen receptor (ER) and progesterone receptor (PR)together referred to as hormone receptor (HR)and human epidermal growth factor receptor 2 (HER2). Breast cancer subtypes were classified as ER or PR positive and HER2 negative (HR+/HER2), ER or PR positive and HER2 positive (HR+/HER2(+)), ER and PR negative and HER2 positive (HR/HER2(+)), and ER, PR, and HER2 negative (triple-negative). We calculated and compared age-specific incidence rates, incidence rate ratios, and 95% confidence intervals by subtype and race (black, white, Hispanic, and Asian). All P values are two-sided. Results We did not observe an age-related blackwhite crossover in incidence for any molecular subtype of breast cancer. Compared with white women, black women had statistically significantly higher rates of triple-negative breast cancer at all ages but statistically significantly lower rates of HR+/HER2 breast cancers after age 35 years (all P < .05). The age-specific incidence of HR+/HER2(+) and HR/HER2(+) subtypes did not vary markedly between white and black women. Conclusions The blackwhite crossover in breast cancer incidence occurs only when all breast cancer subtypes are combined and relates largely to higher rates of triple-negative breast cancers and lower rates of HR+/HER2 breast cancers in black vs white women.