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June 19, 2013

Incidence Rate of Breast Cancer in Young Women—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Seattle Children's Hospital, University of Washington, Seattle (Dr Johnson and Mr Chien) (rebecca.johnson@seattlechildrens.org); and St Charles Health System, Central Oregon and Oregon Health and Science University, Portland (Dr Bleyer).

JAMA. 2013;309(23):2433. doi:10.1001/jama.2013.6464

In Reply: Drs Hou and Huo suggest that we should correct for missing data on receptor status in the SEER database. Using the method1 cited by Hou and Huo, we calculated that for 25- to 39-year-old women diagnosed with distant stage breast cancer during 1992-2009, the APC after correcting for missing values was 3.85 (95% CI, 1.61 to 6.15; P = .002) for ER+PR+ disease and 3.32 (95% CI, 0.81 to 5.90; P = .01) for ER+PR− disease. The APCs for ER−PR+ and ER−PR− were −6.24 (95% CI, −10.53 to −1.74; P = .01) and 2.01 (95% CI, 0.44 to 3.60; P = .02), respectively. Thus, we again find that the incidence of ER+PR+, ER+PR−, and ER−PR− disease in young women is increasing. The ER−PR+ receptor status was initially nonsignificant but decreased with significance after the correction. We agree that divergent trends exist between the different receptor subtypes, but ER−PR− disease is increasing as are both subtypes of ER+ disease.