1. Breast cancer incidence trends by race/ethnicity Lihua Liu, PhD Juanjuan Zhang, MS Dennis Deapen, DrPH Los Angeles Cancer Surveillance Program University of Southern California

2. Los Angeles County, California Source: 2006-2008 American Community Survey 3-year estimates Total 9.8 million residents: 2.8 million non-Hispanic white 2.1 million Hispanic white 0.9 million black 1.3 million Asian 0.4 million Chinese 0.3 million Filipino 0.1 million Japanese 0.2 million Korean 36% foreign born 74% entered after 1980

3. Background

6. Generated intense public interest Received lots of media attention Raised awareness on heterogeneity among Asian-Americans Alerted physicians and general public about breast cancer in Asian-Americans Underlined the importance of disaggregating the Asians by ethnicity The Importance of Deapen et al, IJC 2002, 99:747-750

7. Numerators Accurate identification Denominators Lack of official annual estimates CSP population estimates With Asian ethnic details The Challenge of Surveillance by Asian Ethnicity

8. What would the breast cancer incidence trends look like after 1997? The Question

9. Q: What happened in recent years that may have affected breast cancer incidence trends? A: The 2002 report from the Women’s Health Initiative (WHI) Trial - Combined hormone therapy in postmenopausal women was stopped Quiz

10. Clarke CA, Glaser SL, Uratsu CS, Selby JV, Kushi LH, Herrinton LJ. Recent declines in hormone therapy utilization and breast cancer incidence: clinical and population-based evidence. J Clin Oncol. 2006;24(33);e49-50. After the 2002 WHI report

11. MMWR. June 8, 2007 / 56(22);549-553

12. Materials & Methods  Invasive breast cancer, women, 1972-2007  Total 160,935 cases 111,314 NH White 16,562 Black 23,111 Hispanic 2,572 Chinese 3,801 Filipino 2,492 Japanese 1,083 Korean  AAIR, ASIR (2000 US Standard), APC by race/ethnicity & time period

13. Trends of annual age-adjusted (2000 US Standard) incidence rates of invasive breast cancer among women by race/ethnicity, Los Angeles County, CA, 1972-2007

14. Annual percent change (APC) in age-adjusted (2000 US Standard) incidence rates of invasive breast cancer by time period and race/ethnicity, LA Co.

15. Age-specific incidence rates of invasive breast cancer among women by race/ethnicity and time period, Los Angeles County

16. Trends of age-specific incidence rates of invasive breast cancer among women by race/ethnicity, LA Co.

18. Conclusions  Recent declines in breast cancer incidence are limited to certain age/ethnic groups  Breast cancer remains to be a serious threat to women, especially Asian-Americans  Lifestyle/environmental factors are important in the development of breast cancer  Study of breast cancer among immigrants may help identify risk factors and protective lifestyle factors in breast cancer development