Breast Cancer Estrogen Receptor by Biological Generation: US Black & White Women, Born 1915–1979

Abstract

Evidence suggests contemporary population distributions of breast cancer estrogen receptor (ER) status may be shaped by earlier major societal events, such as the 1965 abolition of Jim Crow (legal racial discrimination in the US) and the Great Famine in China (1959–1961). We accordingly analyzed changes in ER status in relation to Jim Crow birth place among the 46,417 black and 339,830 white US-born non-Hispanic women in the 13 SEER Registry Group who were born between 1915 and 1979 and diagnosed (age 25–84, inclusive) between 1992–2012. We grouped the cases by birth cohort and quantified the rate of change using the haldane (which scales change in relation to biological generation). The % of ER+ cases rose by birth cohort (1915–1919 to 1975–1979) only among women diagnosed before age 55. Changes by biological generation were greater for black vs. white women, and among black women, were greatest among those born in Jim Crow vs. non-Jim Crow states, with this group the only one to exhibit high haldanes (>|0.3|, indicating high rate of change). Our study's analytic approach and findings underscore the need to consider history and societal context when analyzing breast cancer ER status and racial/ethnic inequities in its distribution.

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