Projections for 2030: Increase in ER-Positive, Decrease in ER-Negative Breast Cancer

Phoebe Starr

May 2015, Vol 6, No 4 - AACR Meeting Highlights


Philadelphia, PA—Over the next 15 years, up to a 50% increase is projected in the number of breast cancer cases, according to a study from the National Cancer Institute (NCI). The incidence of estrogen receptor (ER)-positive breast cancers, diagnosed mostly by mammography, is projected to increase, whereas cases of ER-negative cancers, the more-difficult-to-treat cancers, are projected to decrease. ER-positive in situ cancers are expected to increase by approximately 50% and ER-negative cancers are expected to decrease by approximately 50% by 2030.

This analysis predicts that women will be older at breast cancer diagnosis, with a projected increase from 24% of all cases of breast cancer to 35% in the group of women aged 70 to 84 years. These projections can help with resource allocation for management.

“How do we plan for a better future? Our data suggest some clues about what we would like to know about moving forward,” said Philip S. Rosenberg, PhD, Senior Investigator at the NCI.

“Knowing more about how to manage the clinical burden, especially among women aged 70 to 84, would be helpful. Also, we need to know more about the natural history of these in situ lesions. It would be useful to clarify all of the reasons for the decline in ER-negative tumors, because there may be a hidden prevention clue in that. Finally, it would be useful to make future estimates for each racial or ethnic group, which we plan to do,” Dr Rosenberg added.

Key Projections

The estimates for this study used statistical modeling, incorporating more than 500,000 cases of breast cancer included in the SEER (Surveillance, Epidemiology, and End Results) registry through 2010. The modeling accounted for age at diagnosis on a year-by-year basis, and adjusted for the “Betty Ford” effect (ie, during the years after she announced that she had breast cancer, more breast cancers were diagnosed).

An earlier study by the same group of investigators projected cancer burden through 2016. That study predicted a decline in ER-positive tumors in the 50- to 69-year age-group as a result of a decline in the use of hormone therapy. The main 15-year projections of the current study included:

  • Change in total cases of breast cancer from 283,000 in 2011 to 441,000 in 2030, a 50% increase
  • Older age at diagnosis—age 70 to 84 years accounting for 35% of all cases, up from 24% in 2014
  • An increase in ER-positive in situ tumors from 19% to 29%
  • A decrease in ER-negative tumors from 17% to 9%.

Future Opportunities

“These are powerful and important data for the future. It is important to understand where the disease burden will be as we move forward with an aging and diverse population. What we would like to see is a reduced incidence of breast cancer,” said press conference moderator Louis M. Weiner, MD, Director of the Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.

“There appears to be a greater increase in rates of ER-positive and in situ breast cancer than previously appreciated. This modeling study does not tell us causes, but it suggests opportunities for research. For example, it would be great to identify the factors responsible for the decline in ER-negative tumors. The data will also help us in apportioning research dollars. These massive data sets point out areas where we need more research,” Dr Weiner said.