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Triple-negative breast cancer incidence in the United States: ecological correlations with area-level sociodemographics, healthcare, and health behaviors

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Abstract

Purpose

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer, more commonly diagnosed among black women than other subgroups. TNBC varies geographically, but little is known about area-level characteristics associated with elevated incidence.

Methods

We generated 2011–2013 age-adjusted TNBC incidence rates for state economic areas (SEAs) in 43 states using data from North American Association of Central Cancer Registries. For cases missing data on molecular markers, we imputed TNBC status using cross-marginal proportions. We linked these data to SEA covariates from national sources. Using linear ecological regression, we examined correlates of TNBC incidence rates for the overall population and for age (< 50 years or 50 + years)- or race (white or black)-specific subgroups.

Results

The mean annual incidence of TNBC across SEAs was 13.7 per 100,000 women (range = 4.5–26.3), with especially high and variable rates among African American women (mean = 20.5, range 0.0–155.1). TNBC incidence was highest in South Atlantic and East South Central Census Divisions and lowest in Mountain Division. Overall TNBC incidence was associated with SEA sociodemographics (e.g., percent of females age 45 + who are non-Hispanic black: coefficient estimate [est.] = 1.62), healthcare characteristics (e.g., percent of population without health insurance: est. = − 0.52), and health behaviors (e.g., prevalence of obesity among women: est. = 0.72) (all p < 0.05). Other variables related to TNBC incidence included density of obstetrician/gynecologists and prevalence of smoking.

Conclusion

TNBC incidence varied across SEAs in the U.S., particularly for African American women. Identifying areas with elevated TNBC incidence can facilitate research and interventions on area- and individual-level correlates of TNBC.

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Acknowledgements

These data are based on the NAACCR December 2016 data submission. Support for cancer registries is provided by the state, province or territory in which the registry is located. In the U.S., registries also participate in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program or the Centers for Disease Control and Prevention’s National Program of Cancer Registries (NPCR) or both. In Canada, all registries submit data to the Canadian Cancer Registry maintained by Statistics Canada. The opinions expressed in this article are the authors’ own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government.

Funding

The authors completed this work as part of active duty at the National Cancer Institute. No additional funding to support this project was received.

Author information

Authors and Affiliations

  1. Cancer Prevention Fellowship Program, National Cancer Institute, Bethesda, MD, 20892, USA

    Jennifer L. Moss

  2. Department of Family and Community Medicine, Penn State College of Medicine, 134 Sipe Ave., #205, MC HS72, PO Box 850, Hershey, PA, 17033, USA

    Jennifer L. Moss

  3. Surveillance Research Program, National Cancer Institute, Bethesda, MD, 20892, USA

    Zaria Tatalovich, Li Zhu & Kathleen A. Cronin

  4. Center for Global Health, National Cancer Institute, Bethesda, MD, 20892, USA

    Camille Morgan

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  1. Jennifer L. Moss
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  5. Kathleen A. Cronin
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Contributions

JLM obtained, analyzed, and interpreted the data and drafted the manuscript. ZT assisted with data analysis and interpretation, and revised the manuscript. LZ assisted with data analysis and interpretation, and revised the manuscript. CM contributed to data cleaning, analysis, and interpretation, and revised the manuscript. KAC provided study oversight and assisted with data interpretation, and revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jennifer L. Moss.

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Moss, J.L., Tatalovich, Z., Zhu, L. et al. Triple-negative breast cancer incidence in the United States: ecological correlations with area-level sociodemographics, healthcare, and health behaviors. Breast Cancer 28, 82–91 (2021). https://doi.org/10.1007/s12282-020-01132-w

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