2013 Marin County Data Summary: Breast Cancer Trends and Risk Factors

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1 Age-adjusted mortality rate Age-adjusted incidence rate 2013 County Data Summary: Breast Cancer Trends and Risk Factors Age-adjusted Invasive Breast Cancer Incidence Rates and California Non-Hispanic, White Females, California Year of diagnosis Source: California Cancer Registry Web Query Tool, California Department of Public Health, Accessed 8/8/2013 In general over the past 20 years, the incidence rate of female breast cancer among Non-Hispanic Whites has been higher in County than in California as a whole. 1 The incidence of female breast cancer among Non-Hispanic Whites was at its highest level in in both County and California. 1 The average annual incidence rate of female breast cancer among Non-Hispanic Whites in County in was 144 per 100,000 compared to a rate of 142 per 100,000 in California. 1 Age-adjusted Invasive Breast Cancer Mortality Rates and California Non-Hispanic, White Females, California Year of death Source: California Cancer Registry Web Query Tool, California Department of Public Health, Accessed 8/8/2013 The death rate due to female breast cancer among Non-Hispanic Whites was lower in County than in California in , though the difference is not significant. 1 The death rate due to female breast cancer among Non-Hispanic Whites has decreased significantly in both County and California between and

2 Incidence Rates by County County The breast cancer incidence rate during among White Non-Hispanic females in County (152.7) is higher than the overall female breast cancer incidence rate among White Non-Hispanic Females in California (140.6). 2 The entire San Francisco Bay Area has elevated rates of invasive breast cancer among White Non- Hispanic women. 2

3 Mortality Rate per 100,000 Incidence Rate per 100,000 Incidence and Mortality Rates by Age 700 Invasive Breast Cancer Incidence Rate by Age of Diagnosis among Non-Hispanic White Females, County and the United States, US Under * * * 80-84* 85+ Age at Diagnosis The breast cancer incidence rate among Non-Hispanic White females is higher in County than in the US for all age groups except ages 85+ where the rates were very similar. The rates are statistically significantly higher in for the age groups 45-49, 50-54, and Breast cancer incidence in the U.S. increases with age until approximately age 80 when women may be less likely to be screened and diagnosed or may be more likely to die of other more common causes, such as heart disease, rather than breast cancer. 3 Breast Cancer Mortality Rate by Age of Diagnosis among Non-Hispanic, White Females, County and the United States, US under Age at Death The breast cancer mortality rate among Non-Hispanic, White women is not higher in County compared with the U.S. for all age groups, but is significantly higher for women ages compared with U.S. women in the same age group. 4 In the United States and generally in, the breast cancer mortality rate increases with increasing age. 4

4 Age-adjusted mortality rate Age-adjusted Incidence Rate Incidence and Mortality Rates by Race/Ethnicity Female Breast Cancer Age-Adjusted Incidence Rate by Race/Ethnicity County, All races White Black Hispanic Asian Race/Ethnicity The breast cancer incidence rate is highest among White females in County. 1 The breast cancer incidence rate is lowest among Asian/Pacific Islander women in County. 1 During this time period, County rates overall were the second highest in California; rates in Non- Hispanic White women were fifth highest in California, and rates in Hispanic women were the highest in California. 1 Female Breast Cancer Age-Adjusted Mortality Rate by Race/Ethnicity, County, All Races White Hispanic Asian or Pacific Islander Race/Ethnicity As with incidence rates, Whites have the highest mortality rates, followed by Hispanics and Asian/ Pacific Islanders. 1 Mortality rates for Blacks in County could not be calculated due to fewer than 15 deaths in the time period. 1

5 Percent Breast Cancer Risk Factors What raises a woman s chance of getting breast cancer? 5,6 There are several factors that may affect your risk of developing breast cancer. These include: Getting older. Not having children, or having your first child later in life (after age 30). Starting your first menstrual period at an early age (before age 12). Beginning menopause at a late age (after age 55). Having a personal history of breast cancer or certain benign breast diseases, such as atypical ductal hyperplasia. Having close family relatives (such as a mother, sister, father, or daughter) who have had breast cancer. Having a genetic condition, such as certain mutations in your BRCA1 or BRCA2 genes. Having been treated with radiation therapy to the breast or chest. Being overweight, particularly after menopause. Using hormone replacement therapy for 5 or more years. Using oral contraceptives. Drinking alcohol (2+ drinks daily). Being physically inactive Selected Breast Cancer Risk Factors in Women Mother's Age When First Child Was Born Among Women Currently Ages 30+ Women's Study 35% 25% 38% 57% of MWS participants had no children or had their first child after age 30 26% 18% 15% 13% 5% 4% < Never given birth Mother's Age Group Not having children or having children after age 30 is a risk factor for breast cancer. 5,6 57% of the mammography population are at increased risk for breast cancer based on this risk factor. 8

6 Percent Percent Age at First Period, MWS Participants age % % 9-11 years years 15+ years Age at First Period Women who have had more menstrual cycles, by starting their periods at a younger age and/or reaching menopause at a later age, are considered at higher risk for breast cancer. 5,6 An age at first period younger than age 12 and age at menopause after age 55 are considered risk factors for breast cancer. 5,6 18% of the mammography population would be at increased risk for breast cancer based on the age they started their period. 8 7% of the mammography population reached menopause after age 55 and could be at higher risk for breast cancer. 8 Behavioral Risk Factors Overweight or Obese Weight Status Based on BMI Among Women Age 50+, County and California, California % 57% California Obesity, especially after menopause, has been associated with breast cancer. 5,6 39% of women compared with 57% of California women over age 50 are obese placing them at increased risk for breast cancer. 7

7 Percent Percent Prevalence Utilization and 95% C.I. Behavioral Risk Factors (Continued) Hormone Therapy Utilization Among White Non-Hispanic Women 50+, MWS Estrogen plus progestin Estrogen Only Prolonged use of hormone therapy is a risk factor for breast cancer. 5,6 Use of combination hormone therapy steadily decreased in the 2000s. 10 7% of women age 50+ reported using combination hormone therapy in which may place them at increased risk for breast cancer % 35% 25% 15% 5% 6 5 Year Past Year Average Daily Alcohol Consumption MWS Women ages % Physical Activity Among Women Ages 18+ County, California, % No physical activity* 36% 48% Some physical activity No drinking <1 per day per day 2+ per day 44% of women engage in moderate or vigorous physical activity. 22% 22% Moderate Vigorous physical activity physical activity of women in the MWS reported drinking one or more alcoholic beverages a day in the past year, of which reported drinking two or more alcoholic beverages per day. 8 67% of women reported drinking alcohol in the past month compared with only 49% of California women. 9 Among those women who reported drinking, 18% of women drank on 21+ days in the past month compared with only 7% of California women. 9 46% of women who drank on 21+ days in the past month drank 2+ drinks per day compared with 5 of California women. 9 Approximately 6% of women and 2% of California women drank 2 or more drinks per day on 21+ days per month, placing them at increased risk for breast cancer. 9 Physical activity reduces breast cancer risk. 5,6 Only 44% of women engage in moderate or vigorous physical activity which could reduce their breast cancer risk. 7 *statistically unstable

8 Mammogram Screening In , 81% of women over 40 had received a mammogram in the past 2 years. 7 Women who were above the poverty level but below 20 poverty were less likely to have had a mammogram in the past two years than women in the lowest and two highest income groups. 7 Use of mammography did not differ significantly by race. 11 Use of mammography was lower in those with some college education compared to those with high school or less, or a college degree or higher. 7 The percent of women who received a mammogram in the past two years differed most markedly by insurance status. Women who were currently insured were much more likely to have had a mammogram in the past two years than women who were not currently insured. 7 Time Since Last Mammogram among Women Ages 40+, County, California, % 15% 2 years or less More than 2 years ago Never had a mammogram* Mammogram in the Past 2 Years by Federal Poverty Level among Women Ages 40+ County, California, % 64% 76% 4% 84% 0-99% FPL* % FPL* % FPL* 30 FPL + Mammogram in the Past 2 Years by Race/Ethnicity among Women Ages 40+, County, California, 2005 For additional information, please contact: County Department of Health and Human Services Epidemiology Program EPI@marincounty.org or visit Sources: 1. California Cancer Registry. (2010). Cancer Incidence/Mortality Rates in California. Retrieved (8/8/13) from 2. National Cancer Institute. State Cancer Profiles. Created by statecancerprofiles.ca.ncer.gov on 8/16/ Surveillance, Epidemiology, and End Results (SEER) Program ( SEER*Stat Database: Incidence - SEER 13 Regs Research Data, Nov 2012 Sub ( ) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2013, based on the November 2012 submission. 4. Surveillance, Epidemiology, and End Results (SEER) Program ( SEER*Stat Database: Mortality - All COD, Aggregated With County, Total U.S. ( ) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April Mayo Clinic. Breast Cancer Risk Factors. health/breast-cancer/ds00328/dsection=risk-factors. Accessed 11/2/ American Cancer Society. Learn About Cancer. Breast Cancer. Accessed 11/2/ California Health Interview Survey. CHIS Los Angeles, CA: UCLA Center for Health Policy Research. 8. Women s Study. County Department of Health and Human Services California Health Interview Survey. CHIS Los Angeles, CA: UCLA 10. Ereman et al. Recent trends in hormone therapy utilization and breast cancer incidence rates in the high incidence population of County, California California Health Interview Survey. CHIS Los Angeles, CA: UCLA Center for Health Policy Research. 86% 82% Latino* 83% High school or less* White (nonlatino) Mammogram in the Past 2 Years by Insurance Status among Women Ages 40+ County, California, % 67% 68% African American (non-latino)* 81% Other* Mammogram in the Past 2 Years by Highest Education Received among Women Ages 40+ County, California, % 75% Asian (nonlatino) 88% 84% Some College* BA/BS Post-college education Currently insured Not currently insured