Abstract
PurposeDistant relapse metastatic breast cancer (rMBC) incidence and survival are vital measures of breast cancer diagnosis and treatment progress over time.MethodsWe conducted a retrospective cohort study of stage I–III invasive breast cancer, 1990–2011, follow-up through 2016 [N = 8292, rMBC = 964 (12%)] at a community-based institution. Patient and tumor characteristics (treatment, distant recurrence, vital status) from BC registry data were evaluated. Survival analysis and Cox proportional hazards (HzR) with 95% confidence intervals (95% CI) were calculated using distant recurrence and distant disease-specific survival (DDSS) endpoints.ResultsBoth 5- and 10-year distant relapse (rMBC) declined over time from 1990–1998 to 2005–2011 [11% to 5%, 16% to 8% (p < 0.001)]. Proportionately, HER2 + BC distant relapse decreased 9% and triple negative (HR−/HER2−) increased 8% (p = 0.011). In the Cox model, lower stage [stage I: HzR = 0.08 (0.07, 0.10), stage II: 0.29 (0.25, 0.33)], more recent diagnosis years [1999–2004: HzR = 0.60 (0.51, 0.70), 2005–2011: HzR = 0.44 (0.38, 0.52)], HR+ [HzR = 0.62 (0.53, 0.72)], and age 40+ [HzR = 0.81 (0.67, 0.98)] had decreased rMBC risk. Compared to HR+/HER2− BC, triple-negative BC had increased rMBC risk [HzR = 2.02 (1.61, 2.53)] but HER2+ subtypes did not. HR−, age 70+, > 1, or visceral metastases and stage III disease were associated with worse DDSS. DDSS did not improve over time.ConclusionrMBC incidence declined over time with decreased HER2-positive distant recurrence, a shift to more triple-negative BC and consistently poor distant disease survival.
Highlights
An estimated 252,710 new cases of invasive breast cancer will be diagnosed in 2017 with 40,610 breast cancer-related deaths in the same year [1]
As metastatic breast cancer is incurable and recurrent distant metastatic breast cancer (rMBC) composes the largest portion of metastatic breast cancer cases, rMBC incidence, type and survival describe the majority of women affected
We observed a sharp decline in rMBC incidence over time
Summary
An estimated 252,710 new cases of invasive breast cancer will be diagnosed in 2017 with 40,610 breast cancer-related deaths in the same year [1]. Cancer of the breast is the most common type among women and the number two cause of death from cancer among women [2]. WA, USA 3 Metastatic Breast Cancer Alliance, New York, NY, USA 4 Swedish Cancer Institute, Seattle, WA, USA cancer (MBC) in the US in 2017, 25% with de novo MBC and 75% of with recurrent MBC [3]. In our comparison of de novo (dnMBC) and recurrent distant metastatic breast cancer (rMBC), incidence of rMBC declined over time while dnMBC incidence remained constant [4]. As metastatic breast cancer is incurable and rMBC composes the largest portion of metastatic breast cancer cases, rMBC incidence, type and survival describe the majority of women affected
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