{"doi":"10.1002/cncr.33261","title":"The Women's Health Initiative; hormone replacement therapy; and Surveillance, Epidemiology, and End Results data","abstract":"The use of the Surveillance, Epidemiology, and End Results (SEER) program by Chlebowski et al1 inspired an analysis with ages that are more in keeping with inclusion criteria for the Women's Health Initiative (WHI).2 For Black and White women aged 50 to 64 years and Black and White women aged 65 to 79 years, SEER*stat 8.3.6 calculated annual 1992 to 2014 incidence rates and SEs for invasive mammary carcinomas with relevant histologic diagnoses (codes 8095/3, 8140-8141/3, 8255/3, 8260/3, 8314-8315/3, 8500-8502/3, 8507/3, 8514/3, 8521-8524/3, 8530/3, 8540-8541/3, 8562/3, 8570-8575/3, and 8520/3) and none diagnosed from autopsy only from SEER 13 cancer registries.3 The Joinpoint Regression Program 4.8.0.1 calculated point estimates and SEs of annual percent changes (APCs) of rates and years when the APC changed, so-called joinpoints. Joinpoint 4.8.0.1 also performed the parallelism test. Because the test rejected the theory that White women aged 50 to 64 years and 65 to 79 years had the same joinpoints and APCs (P = .006), age groups were analyzed individually. However, because the test did not reject this theory for Black women (P = .10), age groups were analyzed together. When the P value was <.05, the results were deemed statistically significant; otherwise, they were considered nonsignificant. Rate changes with absolute APC values of 0.0 to 0.9 were deemed slow, those with absolute APC values of 1.0 to 1.9 were deemed moderate, those with APC values of 2.0 to 3.0 were deemed rapid, and those with APC values >7.0 were deemed extremely rapid. Figure 1 displays results of Joinpoint regression analyses. For White women aged 50 to 64 years, a significant, rapid decline in the rate for 2000 through 2004 of −2.9 APC was preceded by a nonsignificant, slow rate decline of −0.2 APC, followed by a period (2004-2017) without a rate change (0.0 APC). For White women aged 65 to 79 years, the year 1992 had the highest recorded rate, at 824.5 diagnoses per 100,000 women-years. A nonsignificant, rapid decline in the rate for 1992 through 1994 of −2.5 APC was followed by a nonsignificant, moderate rise in the rate for 1994 through 1998 at 1.0 APC. A significant, rapid decline followed in the rate for 1998 through 2004 at 2.3 APC. A nonsignificant, slow rise in the rate for 2004 through 2013 of 0.4 APC was followed by a nonsignificant, slow rate decline of −0.9 APC. The findings suggest that, for White women aged <80 years who are insured by Medicare, rates began declining before 2000, and possibly as early as 1992. For both groups of White women, joinpoint regression estimated that rate declines began before the 2001 WHI publication,2 thereby calling into question the relationship between the WHI and breast cancer incidence. For Black women, a nonsignificant, slow rate decline for 1992 through 2005 of −0.2 APC was followed by a significant, moderate rise in the rate for 2005 through 2012 of 1.1 APC, and a significant, rapid decline in the rate for 2012 through 2017 of −2.0 APC. Because life expectancy increases over time, assuming constancy over a long period of proportions of a population corresponding to age groups >49 years deflates age-adjusted rates before and inflates them after the set point. Chlebowski et al1 age-adjusted rates to the US standard population in the year 2000, resulting in the appearance, denied by this analysis, of a 40-year increase in breast cancer rates among Black women, and a failure to find the rapid decline in breast cancer rates among Black women since 2012. A joinpoint regression analysis of hormone replacement therapy (HRT) prescription data from the Medical Expenditure Panel Survey4 found 2 significant, extremely rapid declines in prescriptions for women aged ≥50 years: −26.2 APC for 2001 through 2004 and −10.3 APC for 2004 through 2012. The analysis performed in that study,4 which was not of mammary carcinoma rates in toto but rather of invasive ductal carcinoma rates and invasive lobular carcinoma rates, fo","journal":"Cancer","year":2020,"id":131658,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":0.0,"corpus_rank":10062,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.762,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":585782,"name":"Mitchell S. Wachtel","orcid":"0000-0003-0589-6507","position":0,"is_corresponding":true}],"reference_count":4,"raw_metadata":null,"created_at":"2026-07-18T23:16:03.875886Z","pmid":"33170507","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}