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Purpose: Low socioeconomic background (SB) has been associated with lower breast cancer (BC) incidence and higher BC mortality. One explanation of this paradox is the higher frequency of advanced BC observed in deprived women. However, it is still unclear if SB affects similarly BC incidence. This study investigated the link between SB and early/advanced BC incidence from Loire-Atlantique/Vendee Cancer registry data (France)., Materials and Methods: Fourteen thousand three hundred fifty three women living in the geographic area covered by the registry and diagnosed with a primary BC in 2008-2015 were included. SB was approached by a combination of two ecological indexes (French European Deprivation Index and urban/rural residence place). Mixed effects logistic and Poisson regressions were used, respectively, to estimate the odds of advanced (stage ≥ II) BC and the ratio of incidence rates of early (stage 0-I) and advanced BC according to SB, overall and by age group (< 50, 50-74, ≥ 75)., Results: Compared to women living in affluent-urban areas, women living in deprived-urban and deprived-rural areas had a higher proportion of advanced BC [respectively, OR = 1.11 (1.01-1.22), OR = 1.60 (1.25-2.06)] and lower overall (from - 6 to - 15%) and early (from - 9 to - 31%) BC incidences rates Advanced BC incidence rates were not influenced by SB. These patterns were similar in women under 75 years, especially in women living in deprived-rural areas. In the elderly, no association between SB and BC frequency/incidence rates by stage was found., Conclusion: Although advanced BC was more frequent in women living in deprived and rural areas, SB did not influence advanced BC incidence. Therefore, differences observed in overall BC incidence according to SB were only due to higher incidence of early BC in affluent and urban areas. Future research should confirm these results in other French areas., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Socioeconomic deprivation has been associated with lower breast cancer (BC) survival, but the influence of stage at diagnosis on this association merits further study. Our aim was to investigate this association using the Loire-Atlantique/Vendee Cancer Registry (France)., Methods: Twelve-thousand seven-hundred thirty-eight women living in the area covered by the registry and diagnosed with invasive breast carcinoma between 2008 and 2015 were included in the study. They were censored at maximal 6 years. Deprivation was measured by the French European Deprivation Index. Excess hazard and net survival were estimated for deprivation level, stage and age at diagnosis using a flexible excess mortality hazard model., Results: After adjustment by stage, women living in the most deprived areas had a borderline non-significant higher excess mortality hazard (+25% (95% CI: -3%; +62%)) compared to those living in the least deprived areas. Stage-adjusted 5-year net survival differed significantly between these two subgroups (respectively, 88.2% (95% CI:85.2%-90.5%) and 92.5% (95% CI:90.6%-93.9%))., Conclusion: BC survival remained lower in deprived areas in France, despite universal access to cancer care. Intensification of prevention measures could help to reduce advanced BC, responsible for the majority of deaths from BC. A better understanding of remaining social disparities is crucial to implement specific interventions., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective A decrease in advanced breast cancer incidence is considered an early indicator of breast cancer mortality reduction in a screening programme. We describe trends in breast cancer incidence according to tumour size and age in three French administrative areas, where an organized screening programme was implemented during the 1990s. Methods Our study included all 28,092 invasive breast cancers diagnosed from 2000 to 2010 in women living in three areas (Hérault, Isère, Loire-Atlantique). Age, year of diagnosis, and size of tumour at diagnosis was provided by the three area cancer registries. Poisson regression models were fitted to estimate changes in incidence over time, after adjustment for age and administrative area. Results From 2000 to 2010, the incidence rate of large (tumour size >20 mm) breast cancer linearly decreased in women aged 50-74 (target age of the screening programme) from 108.4 to 84.1/100,000 (annual percent change = -1.9%, p < 0.001). No change in large breast cancer incidence rate was found in women aged 20-49, or older than 74. Conclusions A decreasing trend in incidence of large tumour size breast cancer in the target age of the screening programme is demonstrated for the first time in France. The overall 20.9% linear decrease over 11 years in these three areas is encouraging and should be closely monitored and extended to other areas of France, where the screening programme was generally implemented only in 2004.

Purpose: The aim of this population-based study was to estimate short-term and long-term survival of interval breast cancers and to compare them to clinically detected cancers, taking into account prognostic features., Methods: This study included all interval cancers and clinically detected cancers diagnosed in the Loire-Atlantique population-based cancer registry from 2000 to 2010 in women aged 50-76 years. We used the Pohar-Perme method to estimate 5- and 10 year net survival rates and a flexible parametric model to compare interval cancer and clinically detected cancer prognosis with and without adjustment for the main prognostic factors (age, stage, histological grade, and phenotype)., Results: This study included 813 interval cancers and 1,354 clinically detected cancers. Interval cancers were diagnosed at a significantly less advanced stage than clinically detected cancers, but more often with a triple-negative phenotype. Interval cancer age-standardised net survival was 88.0% at 5 years (95% CI 84.9-91.2) and 81.7% at 10 years (95% CI 76.9-86.9), whereas clinically detected cancer age-standardised net survival was 77.8% (95% CI 75.1-80.6) and 64.6% (95% CI 60.7-68.7), respectively. After adjustment for covariates, survival no longer differed between interval cancers and clinically detected cancers at 5 and 10 years., Conclusion: Although the interval cancer net survival rate was higher, interval cancers had a similar short-term and long-term prognosis than clinically detected cancers after taking into account the main prognostic factors.

Background: A recent decline in breast cancer incidence rates has been reported in the United States and in Europe. This decrease has been partly attributed to the reduced use of hormone replacement therapy (HRT). No study in Europe has detailed recent breast cancer incidence trends both by hormonal receptor status and mode of detection at an individual level., Methods: We examined trends in breast cancer incidence rates in the French administrative area of Loire-Atlantique between 1991 and 2007, by age, mode of detection, histological subtype, estrogen/progesterone receptor (ER/PR) status and grade. Annual age-standardized breast cancer incidence rates were estimated using the Loire-Atlantique and Vendée Cancer Registry data. Annual percentage changes (APCs) were estimated using an age-adjusted Poisson regression model., Results: Incidence rates of breast cancer increased 3.5% per year in 1991-2003, dropped -4.3% per year in 2003-2006 and increased in 2007 (9.1%). Stratified analyses by age groups showed that the decrease concerned predominantly women aged 50-64 years, whereas an increasing proportion of cancers detected by organized screening was observed in this age group. Among these women, the decline of incidence particularly concerned positive estrogen and progesterone receptor tumors, lobular subtype tumors, and low-grade tumors., Conclusion: The drop in breast cancer incidence rates observed between 2003 and 2006 in women 50-64 years old was greater for ER+PR+ tumors. During the same period, the incidence of breast cancers diagnosed by organized screening increased. These patterns appear consistent with an impact of the reduced use of HRT., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)