Breast Cancer Research and Treatment

, Volume 107, Issue 3, pp 389–395 | Cite as

Hormone replacement therapy, mammography screening and changing age-specific incidence rates of breast cancer: an ecological study comparing two European populations

  • H. M. VerkooijenEmail author
  • V. C. M. Koot
  • G. Fioretta
  • M. van der Heiden
  • M. E. I. Schipper
  • E. Rapiti
  • P. H. M. Peeters
  • J. L. Peterse
  • C. Bouchardy



In 2003, for the first time, US breast cancer incidence rates have fallen. Experts argue whether this is due to the reduced uptake of screening mammography or to lower use of Hormone Replacement Therapy (HRT). This study aims to disentangle the respective impact of screening and HRT on age-incidence rates and histology of breast cancer, by comparing two populations with comparably high levels of screening mammography, but with different prevalence of HRT.


We included all invasive breast cancers recorded at the Geneva cancer registry (n = 4,909) and the Netherlands Cancer Registry (n = 152,428) between 1989–2003. We compared age-specific incidence rates and trends in histological subtyping between the two populations.


Between 1989–1991, incidence rates increased with age in both populations. In 2001–2003, women aged 60–64 years showed highest incidence rates in Geneva, while in the Netherlands incidence rates continued to increase with age. The annual increase in ductal cancer incidence was similar in the Netherlands (2.3%) and Geneva (2.5%), but the annual increase in lobular cancer was sharper in Geneva (10%) than in the Netherlands (5%).


The sharp differences in age distribution and histological subtyping of breast cancer between two European populations are not attributable to screening, since both populations have a high uptake of mammography screening. Since the prevalence of HRT use is very high in Geneva and rather low in the Netherlands, HRT may explain these discrepancies. However, other etiological factors and differences in histological assessment may also have played a role.


Breast cancer Hormone replacement therapy Incidence Population-based Screening 



Dr. H. M. Verkooijen was financially supported by a PROSPER Grant (3233-069350) from the Swiss National Science Foundation.


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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • H. M. Verkooijen
    • 1
    • 2
    Email author
  • V. C. M. Koot
    • 3
    • 4
  • G. Fioretta
    • 1
  • M. van der Heiden
    • 3
    • 4
  • M. E. I. Schipper
    • 5
  • E. Rapiti
    • 1
  • P. H. M. Peeters
    • 6
  • J. L. Peterse
    • 7
  • C. Bouchardy
    • 1
  1. 1.Geneva Cancer Registry, Institute for Social and Preventive MedicineGeneva UniversityGenevaSwitzerland
  2. 2.Department of Community Occupational and Family MedicineNational University of SingaporeSingaporeSingapore
  3. 3.Comprehensive Cancer Center Middle NetherlandsUtrechtThe Netherlands
  4. 4.Association of Comprehensive Cancer CentersUtrechtThe Netherlands
  5. 5.Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
  6. 6.Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
  7. 7.Department of PathologyNetherlands Cancer InstituteAmsterdamThe Netherlands

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