The shape of the hazard function for cancer incidence

A population-based cohort consisting of 126,141 men and 122,208 women born between 1874 and 1931 and at risk for breast or colorectal cancer after 1965 was identified by linking the Utah Population Data Base and the Utah Cancer Registry. The hazard function for cancer incidence is estimated from left truncated and right censored data based on the conditional likelihood. Four estimation procedures based on the conditional likelihood are used to estimate the age-specific hazard function from the data; these were the life-table method, a kernel method based on the Nelson Aalen estimator, a spline estimate, and a proportional hazards estimate based on splines with birth year as sole covariate. The results are consistent with an increasing hazard for both breast and colorectal cancer through age 85 or 90. After age 85 or 90, the hazard function for female breast and colorectal cancer may reach a plateau or decrease, although the hazard function for male colorectal cancer appears to continue to rise through age 105. The hazard function for both breast and colorectal cancer appears to be higher for more recent birth cohorts, with a more pronounced birth-cohort effect for breast cancer than for colorectal cancer. The age specific hazard for colorectal cancer appears to be higher for men than for women. The shape of the hazard function for both breast and colorectal cancer appears to be consistent with a two-stage model for spontaneous carcinogenesis in which the initiation rate is constant or increasing. Inheritance of initiated cells appears to play a minor role.