Geographic excess of estrogen receptor-positive breast cancer

Elevated and more rapidly increasing breast cancer incidence rates have been described for Marin County, California (CA), a homogeneous, high socioeconomic status population for which yearly surveillance is facilitated by its status as a county. The present study evaluates the histology and hormonal phenotype of the excess breast cancer cases occurring in white, non-Hispanic women living in Marin County between 1992 and 2000 and compares them with patterns occurring in the rest of the San Francisco Bay Area (SFBA) and other urban parts of CA. Incidence data for invasive breast cancer histological subtypes and estrogen receptor (ER) and progesterone receptor (PR) status were obtained from the 1992-2000 Surveillance, Epidemiology, and End Results program. Expected numbers for Marin County were computed based on age-specific rates for five other SFBA counties. Incidence rates were age-adjusted to the 2000 United States standard. Marin County breast cancer diagnoses during 1992-2000 compared with other SFBA and other urban CA Surveillance, Epidemiology, and End Results county rates for white, non-Hispanic women consisted of a disproportionate increase in ER+/PR+ tumors. The observed absolute excess (versus expected) numbers of Marin County ER+/PR+ lobular and nonlobular (predominantly ductal) cases were similar; however, the relative increase appeared greatest for lobular breast cancer. The progressive increase in breast cancer incidence rates observed in Marin County over the past decade is occurring in women with high prevalence of risk factors predisposing toward excess development of ER+/PR+ breast cancer.