Abstract
BackgroundPrevious studies found that the risk of breast cancer–related death is greater in estrogen receptor (ER)-negative disease than in ER-positive disease within 5 years of diagnosis, but greater for ER-positive disease than for ER-negative disease more than 5 years after diagnosis. This phenomenon is referred to as ER-positive and -negative crossover. Our aim was to evaluate this crossover by determining the timing of the hazard of breast cancer death by patient, clinical, and tumor factors.MethodsPatients with breast cancer diagnosed between 1990 and 2005 were identified from the Surveillance, Epidemiology, and End Results database. The cohort was evaluated by age at diagnosis, race, tumor ER status, tumor and nodal stage, and tumor grade. Disease-specific (DS) hazard rates were calculated.ResultsOf the 439,444 patients identified, 77.5% had ER-positive disease. Overall, ER-negative to ER-positive DS hazard rates crossed between the years 7 and 8 after diagnosis. Earlier crossover was linked to black or Hispanic race, young age (<40 years), or tumors that were larger, higher grade, or affected the nodes. Young black (<40 years) patients who had a T3/T4 tumor with positive nodes, grade III or undifferentiated, had the earliest crossover, in year 4.ConclusionsThe timing of crossover of death hazard for ER-positive and ER-negative disease varies by clinical and tumor factors. These findings may help guide recommendations regarding the duration of endocrine therapy for patients with ER-positive cancer.
Highlights
Worldwide, two-thirds of breast cancer cases present as estrogen receptor (ER)-positive disease [1,2]
Statistical Analysis Disease-specific (DS) hazard rate was calculated from the date of diagnosis to the date of breast cancer-related death, date last known to be alive, or November 30, 2010, which was the last follow-up date for Surveillance Epidemiology and End Results (SEER) data
Of the 439,444 breast cancer patients identified in the SEER database, 77.5% had ER-positive disease
Summary
Two-thirds of breast cancer cases present as estrogen receptor (ER)-positive disease [1,2]. Despite excellent early outcomes in ER-positive patients treated with endocrine therapy, some patients with ER-positive disease experience recurrence and die from breast cancer more than 5 years after diagnosis [4,5,6,7]. Previous studies found that while the risk of recurrence or death due to breast cancer is greater for women with ER-negative breast cancer than for those with ER-positive breast cancer within the first 5 years after diagnosis, the risk is greater for ER-positive than for ER-negative breast cancer after the first 5 years [7,8,9] This phenomenon is referred to as ER-positive and -negative crossover. Previous studies found that the risk of breast cancer–related death is greater in estrogen receptor (ER)negative disease than in ER-positive disease within 5 years of diagnosis, but greater for ER-positive disease than for ERnegative disease more than 5 years after diagnosis Our aim was to evaluate this crossover by determining the timing of the hazard of breast cancer death by patient, clinical, and tumor factors
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