br Conclusions br Despite overall stagnant or even declining
Despite overall stagnant or even declining CRC incidence among the classically developed Western countries, the cohort eﬀects for CRC
incidence increased as the generations became younger, thereby sig-naling a potential threat of a future CRC resurgence as these younger cohorts reach older ages. On the other hand, upturn of cohort eﬀects among the younger 1960s–1970s cohorts are also observed in the Asian populations, indicating a possible increased risk of CRC for these younger Asian cohorts. Actions that MK-571 sodium salt hydrate pertain to altering lifestyle-related exposures especially during early life are of great importance in addi-tion to genetic studies and improved screening and diagnostic proce-dures in combating young CRC risks in the future.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of conflicting interest
The Authors declare that there is no conflict of interest.
CHUNG Roger Yat-Nork oversaw the successful implementation of the study, the conception and design of the study, acquisition and analysis of the data, interpretation of the results and report writing. TSOI Kelvin, KYAW Moe Htet, LUI Abdul Rashid and SUNG Joseph Jao-Yiu supervised the conception and design of the study, interpreta-tion of the results and report writing.
LAI Francisco TT conducted APCs using partial least square to confirm the results of the APCs using Maximum Likelihood method.
We acknowledge the support from Mr Jonathan Mak for his assis-tance with the formatting of the manuscript and the figures.
Appendix A. Supplementary data
 International Agency for Research on Cancer, Cancer Incidence in Five Continents Time Trends (CI5plus), IARC, Lyon, 2018http://ci5.iarc.fr/CI5plus/Pages/ download.aspx.
 R.Y. Chung, C.M. Schooling, B.J. Cowling, G.M. Leung, How does socioeconomic development aﬀect risk of mortality? An age-period-cohort analysis from a recently Cancer Epidemiology 59 (2019) 29–36
Contents lists available at ScienceDirect
Journal of Pediatric Surgery
A population-based analysis of pediatric breast cancer☆,☆☆
Maggie L. Westfal a, David C. Chang a, Cassandra M. Kelleher b,
a Department of Surgery, Massachusetts General Hospital, Boston, MA
b Department of Pediatric Surgery, MassGeneral Hospital for Children, Boston, MA
Purpose: The purpose of saprophytes study was to evaluate trends in demographics and outcomes of pediatric breast can-cer in a United States population-based cohort.
Methods: The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify all pediatric patients with malignant breast tumors between 1973 and 2014. Analysis was performed using Stata Statistical Software version 13.1. Associations between categorical variables were made using X2 test. Log-rank test was used for univariate survival analysis. Kaplan–Meier analysis investigated five-year survival rates across several variables. Adjusted analysis was performed using a Cox Proportional-Hazards regression.
Results: 134 patients with breast malignancies were identified. Carcinoma was the most prevalent histology (48.5%), followed by fibroepithelial tumors (FETs) (35.1%), and sarcoma (14.2%). FETs were twice as common in black compared to nonblack patients (56.3% vs. 29.0%, p b 0.01). Analyzing histology by stage revealed that 100% of FETs were early stage disease (p b 0.0001). 46.7% of the tumors tested were ER/PR negative, more than twice as many compared to the published adult estimate of 20.0%. Unadjusted survival analysis revealed worse survival for patients with adenocarcinoma/sarcomas, advanced stage, and high grade disease, without a survival difference between races.