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Open Access Highly Accessed Research article

Recent trends in breast cancer incidence in US white women by county-level urban/rural and poverty status

Amelia K Hausauer12*, Theresa HM Keegan13, Ellen T Chang13, Sally L Glaser13, Holly Howe4 and Christina A Clarke13

Author Affiliations

1 Northern California Cancer Center, Fremont, CA, USA

2 University of California San Francisco School of Medicine, University of California San Francisco, San Francisco, CA, USA

3 Division of Epidemiology, Department of Health Research and Policy, Stanford School of Medicine, Stanford University, Stanford, CA, USA

4 North American Association of Central Cancer Registries, Springfield, IL, USA

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BMC Medicine 2009, 7:31  doi:10.1186/1741-7015-7-31

Published: 26 June 2009



Unprecedented declines in invasive breast cancer rates occurred in the United States between 2001 and 2004, particularly for estrogen receptor-positive tumors among non-Hispanic white women over 50 years. To understand the broader public health import of these reductions among previously unstudied populations, we utilized the largest available US cancer registry resource to describe age-adjusted invasive and in situ breast cancer incidence trends for non-Hispanic white women aged 50 to 74 years overall and by county-level rural/urban and poverty status.


We obtained invasive and in situ breast cancer incidence data for the years 1997 to 2004 from 29 population-based cancer registries participating in the North American Association of Central Cancer Registries resource. Annual age-adjusted rates were examined overall and by rural/urban and poverty of patients' counties of residence at diagnosis. Joinpoint regression was used to assess trends by annual quarter of diagnosis.


Between 2001 and 2004, overall invasive breast cancer incidence fell 13.2%, with greater reductions among women living in urban (-13.8%) versus rural (-7.5%) and low- (-13.0%) or middle- (-13.8%) versus high- (-9.6%) poverty counties. Most incidence rates peaked around 1999 then declined after second quarter 2002, although in rural counties, rates decreased monotonically after 1999. Similar but more attenuated patterns were seen for in situ cancers.


Breast cancer rates fell more substantially in urban and low-poverty, affluent counties than in rural or high-poverty counties. These patterns likely reflect a major influence of reductions in hormone therapy use after July 2002 but cannot exclude possible effects due to screening patterns, particularly among rural populations where hormone therapy use was probably less prevalent.