Abstract P3-06-14: Increase in the proportion of stage IV breast cancer amongst young women with newly diagnosed breast cancer, report from the National cancer data base, 1998-2009

Abstract

Abstract Background: A recent SEER study showed a significant increase in the incidence of advanced breast cancer in women 25 to 39 years old. We hypothesized a similar trend amongst newly diagnosed breast cancer patients treated at Commission on Cancer Accredited Cancer Centers in the United States and that such increase is greatest among minority young women. Methods: We utilized data from the National Cancer Data Base to determine the proportion of patients <40 years old who were diagnosed with Stage IV disease from 1998-2009. Patient demographics (insurance, race, income) and tumor characteristics (size, node status, grade, estrogen receptor (ER), histology) were included to compare the risk factors associated with advanced disease between younger and older women. Statistical analyses were performed using both univariate and multivariable logistic regressions in SAS 9.3 (SAS Inc., Cary, NC). Results: A total of 1,955,190 women with newly diagnosed breast cancer were included. The proportion of young women (<40 years old) diagnosed with stage IV breast cancer has increased by 58% between 1998 and 2009 (Table 1). This increase in young women was significantly greater than other age groups with Stage IV disease: 40-54 years old (Δ = 9%), 55-69 (Δ = 13%) and >70 years old (Δ = 17%) (all p<0.001). Amongst women with stage IV disease, women <40 years old compared to women ≥40 years old were more likely to be nonwhite (29% vs. 19%, p<.0001), have grade III tumors (70% vs. 57%, p<.0001), have an estrogen receptor (ER) negative tumor (34% vs. 28%, p<.0001), and have a ductal carcinoma (85% vs. 78%, p<.0001). In the multivariable analysis, young women (<40 yr) remained at significantly greater risk of being diagnosed with stage IV disease (OR = 1.19, 95% CI 1.14-1.24, p<.0001) compared to women ≥40 years old after adjusting for income, race/ethnicity and tumor characteristics. While the proportion of women with stage IV disease has increased between 1998 and 2009, the increasing odds was significantly greater among young women (OR = 1.54) as compared to old women (OR = 1.17) in the risk adjusted multivariable models. Table 1. Trend in proportion of women diagnosed with Stage IV disease according to patient age, 1998 and 2009.Age19982009Age <401.973.12Age 40-541.471.61Age 55-691.591.81Age 70+1.802.11 Conclusions: The proportion of women with stage IV disease under 40 years old has increased significantly over the past decade and this trend was not seen in older age groups. Young minority women with ER negative tumors are at greatest risk to be diagnosed at a later stage. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-14.