Five-year Breast Cancer-specific Survival Research Articles

Racial disparities in presentation and survival for lobular breast cancer.

1596 Background: We characterized differences in presentation and survival, and identified predictors of survival, among women of varying race with lobular breast cancer. We also assessed if these trends were unique to ILC by comparing with invasive ductal carcinoma (IDC) and mixed invasive ductal-lobular carcinoma (IDLC). Methods: Using the SEER database, we performed a population-based retrospective cohort study of women diagnosed with ILC, IDC, and IDLC between 1998 and 2019. We collected race, age, marital status, and income. Clinical data included grade, size, laterality, clinical stage, receptor status, surgery type, chemotherapy, radiation, and breast-cancer-specific survival (BCSS). Differences between racial groups were assessed using Chi-square tests or one-way ANOVA. To identify predictors of survival, Cox-proportional hazard models were constructed. Statistical analyses were performed using SAS and P values < 0.05 were considered significant. Results: 38,769 women with ILC were identified, including 32,857 White, 2398 Black, 2352 Asian, and 1162 women of other race. Black women presented with higher-grade, advanced clinical stage, ER+ disease, N2-3 stage, and lower rates of unilateral/bilateral mastectomy than White women. Black women were more likely to not undergo surgery (7.13%), compared with White (4.25%) and Asian (4.04%) women ( P = .0001). Asian women were younger, had more ER-/PR- ILC, and received more chemotherapy. The five-year BCSS rates in Black, White, Asian, and women of other race were 91.5%, 94.2%, 93.7%, and 95.7%, respectively ( P< .0001). Predictors of worse survival include Black race (HR 1.32, P < .0001), ER-/PR- (HR 2.18, P< .0001), ER+/PR- (HR 1.52, P< .0001), and no surgery (HR 4.19, P < .0001). Radiotherapy was associated with improved survival (HR 0.82, P < .0001), while chemotherapy did not affect survival (HR 1.1, P= 0.0504). In comparing across breast cancer subtypes, Black women similarly present with higher grade tumors, advanced clinical stage, ER+ disease, and had higher rates of surgery omission in IDC and IDLC. However, ER-/PR- subtype was notably higher in ILC among Asian women compared with IDC, whereas Black women have higher rates of ER+/PR+ and ER-/PR- ILC. Black women had the lowest five-year BCSS rates across all breast cancer subtypes. Predictors of worse survival in IDC and IDLC include Black race and negative hormone receptor status, while radiation therapy was associated with improved survival. Conclusions: There are differences in clinical presentation of invasive lobular breast cancer according to race.Black women had more advanced disease, while Asian women were younger. Across all subtypes, overall survival for Black women at 5 years was worse compared to other racial groups. Our data provides insight into the complex interactions of race, clinical characteristics, and survival outcomes in lobular breast cancer, with implications for screening considerations.

Abstract PO5-06-03: Impact of curative-intent treatment on survival for metastatic breast cancer limited to distant lymph nodes

Abstract BACKGROUND: Metastatic breast cancer limited to distant lymph nodes is classified as stage IV but potentially represents an anatomically distinct entity amenable to curative treatment. Its optimal management is unclear, with existing studies limited by small sample sizes and short follow-up durations. We sought to investigate the impact of curative-intent treatment on breast cancer-specific survival (BCSS) and overall survival (OS) for patients with this diagnosis. METHODS: Three cohorts of patients diagnosed with breast cancer from 2010 to 2019 were identified from the Surveillance, Epidemiology, and End Results 17 registries database. The curative cohort consisted of patients with metastatic breast cancer involving only distant lymph nodes who received a combination of chemotherapy, surgery to the primary site, and radiotherapy (curative-intent treatment). The palliative cohort included patients who underwent chemotherapy but not curative-intent treatment. The N3c cohort was comprised of patients with ipsilateral supraclavicular lymph node metastases but no distant metastases who received curative-intent treatment. Weighting based on covariate balancing propensity scores was performed to balance age, sex, race, median household income, year of diagnosis, T stage, histology, pathological grade, and ER/PR/HER2 status between the cohorts. Weight-adjusted multivariable Cox regression models with the same covariates were then used to compare the BCSS and OS of the three cohorts. RESULTS: A total of 2,089 patients with a median follow-up of 37 months were eligible for analysis, of whom 577 (27.6%) were in the curative cohort, 905 (43.3%) were in the palliative cohort, and 607 (29.1%) were in the N3c cohort. After propensity score weighting, the maximal standardized mean difference for all covariates was less than 0.1. Five-year BCSS for patients in the weight-adjusted curative, palliative, and N3c cohorts were 63.0% (95% CI 58.1-68.3), 46.7% (42.4-51.4), and 66.4% (61.4-71.8), respectively; and five-year OS were 57.9% (53.0-63.2), 41.2% (37.2-45.7), and 62.2% (57.3-67.6), respectively. Compared to the palliative cohort, the curative cohort exhibited better BCSS (HR 0.47, 95% CI 0.38-0.57; P< 0.001) and OS (HR 0.48, 95% CI 0.40-0.58; P< 0.001). In contrast, the N3c cohort had similar BCSS (HR 0.93, 95% CI 0.73-1.17; P=0.53) and OS (HR 0.96, 95% CI 0.77-1.19; P=0.68) to the curative cohort. CONCLUSIONS: Patients treated curatively for metastatic breast cancer limited to distant lymph nodes had higher BCSS and OS than those receiving palliative chemotherapy and similar BCSS and OS to patients receiving curative-intent treatment for ipsilateral supraclavicular lymph node metastases. These results support the use of aggressive multimodal therapy for select stage IV breast cancer patients with only distant nodal metastases and, if confirmed, suggest that a substantial portion of such patients may be undertreated. Citation Format: Yang Xu. Impact of curative-intent treatment on survival for metastatic breast cancer limited to distant lymph nodes [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-06-03.

Abstract P4-07-57: Outcomes of Triple-Negative Breast Cancer In Older Versus Younger Women

Abstract Background: Triple-negative breast cancer (TNBC) is an aggressive disease characterized by lack of targeted therapy; main-stay of treatment being limited to surgery and chemotherapy. Older patients with TNBC are often underrepresented in the clinical trials, due to competing mortality risks. This study aims to assess the treatment and outcomes of triple negative breast cancer (TNBC) in older women relative to younger women. Methods: This was a retrospective cohort study of patients who presented with primary TNBC, age 34-94 years; stage I-III from Jan 1, 2013 to Dec 31, 2015. Patients’ demographics, clinical characteristics, treatment and outcomes were retrieved from the CANISC Register and individual patient (N=88). Breast cancer-specific survival (BCSS) was estimated by using Kaplan–Meier method, and adjusted for age, tumor size, tumor grade, nodal status and chemotherapy, using SPSS-19. Results: Fifty-one patients were less than 70 years old (57.9%) and 37 were 70 years and older (42.1%). There was no difference in the stage at presentation (stage I: 43% vs. 35%; stage 2: 49% vs. 49%; stage 3: 8% vs. 11%; P=.061). Older patients were less often treated with adjuvant chemotherapy (75% vs. 24%; P< 0.001). Mean follow-up was 48 months. Five-year BCSS was significantly poor for older patients (54% vs. 75%, P=.032). 5-year overall survival was also significantly worse for patients who did not receive adjuvant chemotherapy (50% vs. 88% P =0< 021). Conclusions: Overall survival in triple negative breast cancer is much worse in older women as compared to younger women and there is a significant benefit with adjuvant chemotherapy. Citation Format: Asma Munir, Saira Khawaja, Sohail Khan, Yousuf Sharaiha, Anita M. Huws. Outcomes of Triple-Negative Breast Cancer In Older Versus Younger Women [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-57.

Using Inflammatory Blood Markers as Useful Prognostic Factors in Patients Undergoing Neo-Adjuvant Therapy for Stage II-III Breast Cancer

<h3>Purpose/Objective(s)</h3> The prognostic value of inflammatory blood markers (IBMs) in breast cancer patients have been an area of growing interest. Most of the studies took parameters from one defined point, usually the pretreatment ones. Current study aims to investigate the potential prognostic significance of IBMs among patients with stage II-III breast cancer receiving neo-adjuvant therapy (NAT). <h3>Materials/Methods</h3> Patients with stage II-III breast cancer who received NAT and postoperative radiotherapy (RT) at a single institute from Jan 2009 to Dec 2016 were retrospectively reviewed. The neutrophil, lymphocyte, platelet and monocyte count were collected at different stages of treatment, after NAT but before surgery, before and after RT, respectively. LMR and SII was calculated for each patient. The breast cancer specific survival (BCSS) and locoregional recurrence free survival (LRRFS) were defined from the date of the start of RT until last follow up. Univariate and multivariate Cox regression analysis was performed to identify independent predictors for BCSS and LRRFS. Model performance was evaluated by the concordance index (c-index). <h3>Results</h3> In total, 205 patients were enrolled. After a median follow-up of 65 months, 19 BCSS events were identified. The optimal cutoff value of SII and LMR after NAT but before surgery by receiver operating characteristic curve were 467.76 × 10⁹ (AUC = 0.63) and 1.57 (AUC = 0.65). The five-year BCSS of the group with lower LMR (LMR≤1.57) and higher LMR (LMR > 1.57) were 74.2% and 93.7%, respectively (P = 0.001). The 5-year risk of BCSS in patients with high SII value (SII > 467.76 × 10⁹) and low SII value (SII≤467.76 × 10⁹) were 81.5% vs 96.4%, respectively, <i>P</i> = 0.003. The multivariate analysis found that in addition to the traditional prognostic factors including hormone receptor, ypT, ypN stage and lymphovascular invasion, both post-NAT LMR (HR = 0.28, 95% CI = 0.10-0.81, <i>P</i> = 0.02) and SII (HR = 4.06, 95% CI = 1.37-12.00, <i>P</i> = 0.01) were independent predictors for BCSS. The C-index of the multivariate model of Neo-Bioscore for BCSS was 0.71(95% CI = 0.83-0.59), which was improved to 0.80((95% CI = 0.94-0.67) by adding LMR and SII. The prognosis of pre-RT and post-RT SII on LRRFS was analyzed in124 patients. The optimal cutoff value of SII before and after RT were 412.2 × 10⁹ (AUC = 0.71) and 571.48 × 10⁹ (AUC = 0.69) respectively. Patients with pre-RT SII > 412.2 × 10⁹ or post-RT SII > 571.48 × 10⁹ had a higher rate of locoregional failure (<i>P</i> = 0.02 and <i>P</i> = 0.01). After adjusting for cT, cN stage and age, post-RT SII remained predictive of locoregional failure (HR = 10.22, 95% CI = 1.25-83.45, <i>P</i> = 0.03). <h3>Conclusion</h3> IBMs after NAT was useful prognostic factor for stage II-III breast cancer patients. Adding LMR and SII to Neo-Bioscore can further stratify the prognosis of BCSS. High level of SII after RT had a negative impact on local-regional control, whether it reflects preclinical studies of post-RT inflammation-mediated tumor recurrence needs further study.

Abstract PS7-63: Cause of death discordance between death certificates and medical files: Impact on cancer survival assessment in a Belgian case study

Abstract Introduction Accurate information on cause of death is essential for correct breast cancer-specific mortality assessment. However, registration and coding of cause of death is prone to error since determining the exact underlying condition related to the death is challenging. In this study, an expert review of medical files was done to determine the principal cause of death for breast cancer patients of a Belgian tertiary hospital. The retrieved cause of death was compared to death certificate information to assess concordance between both sources. Secondly, the impact of discordant reporting on cause-specific survival (CSS) and other net survival approaches were examined. Methods Breast cancer patients diagnosed and treated at University Hospitals Leuven (UHL) between 2009 and 2014 with follow-up until December 31st, 2016, were included in the study. Information on cause of death was obtained from death certificates (following ICD-10 rules) and medical files. The latter were reviewed by a board of experts at UHL. Agreement was calculated using Cohen’s kappa coefficient, and reasons for discordant reporting were assessed. CSS was calculated based on cause of death information from both sources using the Kaplan-Meier method. These survival estimates were compared to the relative survival probability (RS) using the Ederer II and Pohar Perme method. Results A total of 2,862 patients were included, of whom 354 died after a median follow-up of 54.6 months. We found overall substantial agreement (kappa-value of 0.69 (95% C.I.: 0.62-0.77)) between cause of death reported by death certificates and medical files (Table 1). In 84.8% of cases, there was concordance between both methods. When comparing to medical files, misattribution of breast cancer-specific death in death certificates (4.5% of cases) was linked to the presence of comorbidities (43.7%), metastases (37.5%), or unspecified causes (18.8%). Five-year CSS based on medical files (93.1% (95% C.I.: 91.9-94.1)) was only slightly higher compared to CSS based on death certificates (92.3% (95% C.I.: 91.2-93.4)). RS measures using Ederer II and Pohar Perme were comparable to CSS measures. Conclusions Overall, substantial agreement of cause of death was seen between death certificates and medical files. Attribution of cause death to comorbidities was the most common reason for discordant reporting of breast cancer-specific death. Five-year breast cancer-specific survival was slightly higher based on cause of death information from medical files, compared to death certificates. Periodic reviews and implementation of ICD-10 guidelines for classification of cause of death could improve accuracy in cause of death annotation. Table 1: Discordance for the principal cause of death between medical files and death certificatesmedical filesother causesbreast cancerdeath certificatesother causes136 (38.4%)16 (4.5%)152 (42.9%)breast cancer38 (10.7%)164 (46.3%)202 (57.1%)174 (49.2%)180 (50.9%)354 (100%) Citation Format: Hava Izci, Tim Tambuyzer, Jessica Vandeven, Jérôme Xicluna, Hans Wildiers, Kevin Punie, Nynke Willers, Eva Oldenburger, Els Van Nieuwenhuysen, Patrick Berteloot, Ann Smeets, Ines Nevelsteen, Liesbet Van Eycken, Harlinde De Schutter, Patrick Neven, Geert Silversmit, Freija Verdoodt. Cause of death discordance between death certificates and medical files: Impact on cancer survival assessment in a Belgian case study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-63.

Abstract PS6-16: Outcomes for metaplastic breast cancer differ by histologic subtype

Abstract Background: Metaplastic breast carcinoma (MBC) is a rare, aggressive subtype of breast cancer. The majority of MBC has triple negative (TN) receptor status and has been associated with poorer overall survival compared to other TN breast cancers. MBCs constitute a histopathologically distinct and diverse entity, which can be further classified into subtypes. In this study, we report the largest single-institution study of MBC. We aimed to compare survival outcomes among the histologic subtypes of MBC and to compare MBC to a cohort of non-metaplastic TN breast cancer patients. Methods: All pure MBC patients undergoing surgery from 1995-2017 were identified from our prospectively maintained institutional database. Based upon the World Health Organization classification of MBC, tumors were classified by subtype: squamous, spindle, heterologous mesenchymal, or mixed. Primary endpoints included overall survival (OS), breast cancer-specific survival (BCSS), and recurrence-free survival (RFS). A contemporary cohort of non-metaplastic TN breast cancer patients was also identified from our institutional database. Clinicopathologic, treatment, and survival outcomes were compared between the 2 groups. Results: In total, 132 MBC patients were included: 45 heterologous mesenchymal (34.1%), 26 squamous (19.7%), 26 spindle (19.7%), 30 mixed (22.7%), and 6 other (4.5%). Median follow-up time among survivors with MBC was 5.8 years (0-19.4 years). Five-year OS rate was 76% (95% CI 0.68-0.84). Five-year BCSS rate was 79% (95% CI 0.71-0.87). OS and BCSS varied among MBC subtypes. Patients with heterologous mesenchymal subtype had the best OS and BCSS rates, 88% (95% CI 0.78-0.98) and 88% (95% CI 0.78-0.99), respectively. Patients with squamous subtype had the worst OS and BCSS rates, 50% (95%CI 0.26-0.73) and 56% (95%CI 0.32-0.79), respectively. No difference in locoregional recurrence was seen between the groups. TN breast cancer patients presented with smaller tumors than patients with MBC (1.7 vs 2.35 cm, p &amp;lt; 0.001) (Table). However, they were more likely to be pathologically node positive (40% vs 24%, p &amp;lt; 0.001). Kaplan-Meier survival analysis demonstrated improved OS, DSS, and RFS for patients with TN breast cancer compared to MBC. The RFS hazard ratio for MBC compared to TN breast cancer, adjusted for age, year of surgery, type of surgery, and pathologic tumor and nodal staging, was 2.38 (range 1.63-3.26, p &amp;lt; 0.001). Of the 10 MBC patients who received neoadjuvant chemotherapy, 4 progressed while on treatment and 3 had no response. Conclusions: Metaplastic breast cancer is associated with poor survival outcomes compared to TN non-metaplastic breast cancer. The heterologous mesenchymal subtype is associated with the highest BCSS, while the squamous subtype is associated with the lowest BCSS. These data suggest that standard-of-care therapy for TN is not effective for MBC and that research is needed to identify therapies tailored to the unique biology of MBC. Table. Patient, tumor, and treatment characteristicsMetaplastic (n = 132)Non-Metaplastic TN (n = 1767)p-valueMedian Age at Surgery (range)56 years (46, 65)54 years (44,63)0.13Tumor Size (range)2.4 cm (1.5, 3.5)1.7 cm (1.0, 2.5)&amp;lt; 0.001Breast ProcedureMastectomy62 (47%)787 (45%)0.65Lumpectomy70 (53%)980 (55%)Tumor SubtypeHR-/HER2-114 (97%)1767 (100%)&amp;lt; 0.001HR-/HER2+1 (0.9%)0 (0%)HR+/HER2-2 (1.7%)0 (0%)Unknown150 (0%)Family History of Breast CancerNo70 (55%)914 (52%)0.6Yes58 (45%)849 (48%)Unknown44Genetic MutationBRCA1 Pathogenic Mutation9 (27%)145 (31%)0.11BRCA2 Pathogenic Mutation3 (9.1%)42 (9%)Other mutation1 (3%)0 (0%)Negative20 (61%)279 (60%)Not Tested991301Menopausal StatusPostmenopausal83 (63%)1007 (57%)&amp;lt; 0.001Axillary ProcedureSentinel Lymph Node Biopsy91 (69%)1018 (58%)&amp;lt; 0.001Axillary Dissection37 (28%)742 (42%)None4 (3%)7 (0.4%)Pathologic Tumor Staget01 (0.8%)32 (1.8%)&amp;lt; 0.001t156 (42%)1082 (61%)t259 (45%)585 (33%)t311 (8.3%)51 (2.9%)t45 (3.8%)17 (1.0%)Pathologic Nodal Stagen0100 (76%)1065 (60%)&amp;lt; 0.001n125 (19%)486 (28%)n22 (1.5%)126 (7.1%)n31 (0.8%)86 (4.9%)nx4 (3%)4 (0.2%)Radiation TherapyNo59 (45%)585 (33%)&amp;lt; 0.001Yes71 (55%)1164 (67%)Unknown218ChemotherapyAdjuvant118 (92.2%)1358 (77.6%)&amp;lt; 0.001Neoadjuvant10 (7.8%)81 (5%)No0312 (17.8%)Unknown416HR, hormone receptor; TN, triple negative Citation Format: Audree B Tadros, Varadan Sevilimedu, Emily Zabor, Dilip Giri, Monica Morrow, George Plitas. Outcomes for metaplastic breast cancer differ by histologic subtype [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-16.

Associations between the ultrasound features of invasive breast cancer and breast cancer specific survival

To assess whether ultrasound features of breast cancer are associated with breast cancer specific survival (BCSS). Within a single breast service, data was collected prospectively (April 2010-April 2012) from 319 consecutive women (mean age 63 years) with 335 ultrasound-visible invasive breast cancers. Ultrasound features were evaluated retrospectively from the recorded images according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon by a radiologist blinded to outcomes. Survival and cause of death were ascertained from local and national sources. Kaplan-Meier survival curves were generated, and statistical significance tested using the log-rank test. Mean follow-up in those alive was 80.9 months. Thirty breast cancer deaths and 45 non-breast cancer deaths occurred. Five-year BCSS in the presence of distal acoustic enhancement was 76% compared to 88%, 96%, and 100% for those with distal shadowing, no distal effect or combined effect respectively (p<0.0002). Patients with sonographic skin involvement had 73% 5-year BCSS compared to 92% for no skin involvement (p<0.0001). Focal oedema was associated with 56% 5-year BCSS compared to 89% for those without (p=0.0002). A significant association was demonstrated between ultrasound tumour size and BCSS (p<0.0001). At multivariate analysis, skin changes, distal enhancement, and focal oedema maintained prognostic significance. Distal enhancement, focal oedema, and skin involvement have strong associations with breast cancer death. These factors could be taken into account, along with lesion size and other commonly used preoperative prognostic features, when considering management of women with breast cancer.

Metastatic-free intervals and risk of breast cancer-specific mortality among patients with hormone receptor-positive breast cancer: A population-based analysis from the Surveillance, Epidemiology, and End Results registries.

e13034 Background: Patients successfully treated for hormone receptor (HR)-positive early breast cancer remain at risk of recurrence and metastatic disease even after extended periods of disease-free years. Whether prolonged metastatic-free intervals ultimately confer a benefit to breast cancer-specific survival is not well understood. This study aimed to investigate metastatic-free intervals and risk of breast cancer-specific mortality among patients with HR-positive breast cancer after adjuvant therapy. Methods: We conducted a retrospective cohort study of women aged 18 years and older diagnosed with recurrent metastatic HR-positive breast cancer between 1990 and 2016 in the Surveillance, Epidemiology, and End Results registries. Patients with longitudinal information on primary stage I-III HR-positive breast cancer through the occurrence of metastatic disease and survival were included. Risks of breast cancer-specific mortality associated with metastatic-free intervals (defined as time from primary breast cancer diagnosis to metastasis) of ≥5 years compared to &lt; 5 years were estimated. Fine and Gray competing risks regression models were used to calculate subdistribution hazard ratios (SHR) and 95% confidence intervals (CI). Results: Among 1,057 women with HR-positive breast cancer with a median age of 54 years at primary breast cancer diagnosis and 62 years at metastatic progression, 65% of women had a metastatic-free disease interval ≥5 years, whereas 35% had an interval of &lt; 5 years. Overall, patients with metastatic-free intervals &lt; 5 years had a five-year breast cancer-specific survival rate of 31% compared to 52% in women with intervals of ≥5 years. In multivariable analyses adjusted for age, race, diagnosis year, grade, treatment and sites of metastasis, patients with intervals of ≥5 years had decreased risk of breast cancer-specific mortality (SHR = 0.72, 95% CI 0.58-0.89, P = 0.002) compared to women with metastatic-free intervals of &lt; 5 years. Conclusions: In this population-based study, rates of cancer-specific mortality among patients who experienced metastatic recurrence of HR-positive breast cancer were lower in women with metastatic-free intervals of 5 years or more. The results of this study may inform patient-clinician discussions surrounding prognosis and treatment selection among HR-positive patients.

Temporal trends in breast cancer survival by race and ethnicity: A population-based cohort study

IntroductionDifferences in breast cancer survival by race and ethnicity are often assumed to be a fairly recent phenomenon, and are hypothesized to have arisen due to gaps in receipt of screening or therapy. The emergence of these differences in calendar time have implications for identification of their origin. We sought to determine whether breast cancer survival differences by race or ethnicity arose in tandem with the advent of screening or therapeutic advances.Materials and methodsA cohort of women diagnosed with invasive breast cancer from 1975–2009 in 18 population-based registries were followed for five-year breast cancer cause-specific survival. Differences in survival according to race/ethnicity and estrogen receptor status were quantified in Cox proportional hazards models, with estimation of hazard ratios (HR), 95% confidence intervals (CI), and absolute risk differences. For 2010, we also assessed differences in survival by breast cancer subtypes defined by hormone receptor and Her2/neu status.ResultsAmong over 930,000 women, initial differences in five-year breast cancer-specific survival by race became apparent among 1975–1979 diagnoses and continued to be evident, with stronger disparities apparent in those of Black vs. White Non-Hispanic (WNH) race and among estrogen-receptor positive vs. negative disease. Within breast cancer subtype, all included race/ethnic groups experienced disparate survival in comparison with WNH women for triple-negative disease. Black women had a consistent gap in absolute survival of .10-.12, compared with WNH women, from 1975–1979 through all included time periods, such that 5- year survival of Black women diagnosed in 2005–09 lagged more than 20 years behind that of WNH women.DiscussionSurvival differed by race for diagnoses that predate the introduction of mammographic screening and most therapeutic advances. Absolute differences in survival by race and ethnicity have remained almost constant over 40 years of observation, suggesting early origins for some contributors.

The Effect of Post-mastectomy Radiotherapy in Patients With Metaplastic Breast Cancer: An Analysis of SEER Database.

Introduction: Metaplastic breast cancer (MBC) is a rare and aggressive form of breast cancer. The present study aimed to assess the effect of post-mastectomy radiotherapy (PMRT) in MBC patients with intermediate-risk (T1-2N1M0 and T3N0M0) and high-risk (T1-4N2-3M0 and T4N0-1M0) disease.Methods: The Surveillance, Epidemiology and End Results database was used to analyze patients with MBC between 2000 and 2014. Kaplan–Meier analysis, log-rank tests, and the multivariate Cox proportional model were used for statistical analysis.Results: We identified 460 patients with a median follow-up time of 31 months (range, 2–178 months). Five-year breast cancer specific survival (BCSS) for all patients was 57.5%. In the entire group, multivariate analysis showed that PMRT was associated with better BCSS (hazard ratio (HR) 0.500, 95% confidence interval (CI) 0.366–0.683, P < 0.001). The 5-year BCSS in PMRT and non-PMRT groups were 62.3 and 50.3%, respectively (P = 0.001). When stratified the patients into intermediate-risk and high-risk groups, PMRT could improve BCSS compared with that in non-PMRT patients in both the intermediate- and high-risk groups. For the intermediate-risk group, the 5-year BCSS was 74.3 and 64.7% in PMRT and non-PMRT groups (P = 0.042), respectively, and was 52.1 and 28.8% in high-risk patients treated with PMRT and non-PMRT, respectively (P < 0.001).Conclusion: PMRT could improve the BCSS of MBC patients with intermediate- and high-risk disease.

Outcomes in different ethnic groups of New Zealand patients with screen-detected vs. non-screen-detected breast cancer.

Objective To compare characteristics and survival of New Zealand European, Māori, and Pacific women with screen-detected vs. non-screen-detected breast cancer. Methods Women aged 45–69 diagnosed with invasive breast cancer between January 2005 and May 2013 were identified from the Waikato and Auckland Breast Cancer Registries. Patient demographics and tumour characteristics were described by detection mode and ethnicity. Kaplan–Meier method was used to estimate the five-year breast cancer-specific survival of women with stage I–III breast cancer by ethnicity and detection mode. Results Women with screen-detected cancers were older, had smaller tumours, fewer stage IV (0.8% vs. 7.6%), fewer high grade (16.8% vs. 39.0%), and fewer lymph node positive diseases (26.3% vs. 51.5%) than women with non-screen-detected cancers. There were more Luminal A (70.0% vs. 54.0%), fewer human epidermal growth factor receptor 2 positive non-Luminal (4.4% vs. 8.8%), and fewer triple negative cases (7.0% vs. 13.8%) in screen-detected than non-screen-detected cancers. If not screen detected, 22.7% of breast cancers in Pacific women were stage IV compared with 2.4% if screen detected. If not screen detected, the five-year breast cancer-specific survival was 91.1% for New Zealand European women, 84.2% for Māori women, and 80.2% for Pacific women (p-value &lt;0.001). For screen-detected breast cancer, survival between different ethnic groups was similar. Conclusions Breast cancers detected through screening are diagnosed at an earlier stage and have a greater proportion of subtypes, with better outcome. Variations in survival for Māori and Pacific women are only found in women with non-screen-detected breast cancer.

Surgical treatment and prognosis of breast cancer in elderly – A population-based study

BackgroundThe aim of this study was to investigate outcome of treatment in patients over 80 years of age with early breast cancer at the time of the diagnosis with special interest in surgical treatment. Materials and methodsBreast cancer patients older than 80 years of age, treated at the Breast Surgery Unit of Helsinki University Hospital in 2005–2010 were identified from electronic patient records. Patients were followed-up until the end of 2014. Patient and tumour characteristics, recurrences, co-morbidities and reasons for omission of surgery were collected from electronic patient records. Survival data was obtained from Finnish Cancer Registry. Results446 patients were eligible for the study: 401 (90%) received surgery. The median follow-up time was 52 months. In the entire study population, local and regional recurrences/disease progression were diagnosed in 16 (3.6%) and 6 (1.3%) patients, respectively. The five-year overall survival was 50.6% in the surgical treatment and only 15.2% in non-surgical treatment group, p < 0.001. Also, the five-year breast cancer specific survival was significantly better in the patients with surgery, 82.0%, but 56.0% in the patients without surgery, p < 0.001. There was no mortality related to the surgery, but 122 (30%) patients died within three years from surgery. ConclusionSurgical treatment rate was high. OS and BCSS were better in surgically treated elderly patients. Local and regional disease control was excellent, probably due to high rate of surgical treatment. Surgical treatment also seemed safe in this elderly patient population. However, surgical overtreatment was obvious in some patients.

Validation of a Risk Score Incorporating Tumor Characteristics into the American Joint Committee on Cancer Anatomic Stage for Breast Cancer.

PurposeThe American Joint Committee on Cancer 8th edition (AJCC8) prognostic stage (PS) was implemented January 1, 2018, but it is complex due to multiple permutations. A North American group proposed a simpler system using the anatomic stage with a risk score system (RSS) of 1 point each for grade 3 tumor and human epithelial growth factor receptor 2 (HER2) and estrogen receptor (ER) negativity. Here we aimed to evaluate this risk score system with our database of Asian breast cancer patients and compare it against the AJCC8 PS.MethodsPatients diagnosed with breast cancer stage I–IV in 2006–2012 were identified in the SingHealth Joint Breast Cancer Registry. Five-year breast cancer-specific survival (CSS) and overall survival (OS) were calculated for each anatomic stage according to the risk score and compared with the AJCC8 PS.ResultsA total of 6,656 patients were analyzed. The median follow-up was 61 (interquartile range, 37–90) months. There was a high receipt of endocrine therapy (84.6% of ER+ patients), chemotherapy (84.3% of node-positive patients), and trastuzumab (86.0% of HER2+ patients). Within each anatomic stage, there were significant differences in survival in all sub-stages except IIIB. On multivariate analysis, the hazard ratio for negative ER was 1.74 (1.48–2.06), for negative HER2 was 1.49 (1.26–1.74), and for grade 3 was 1.84 (1.55–2.19). On multivariate analysis controlled for age, ethnicity, and receipt of chemotherapy, the RSS (Akaike information criterion [AIC] = 10,649.45; Harrell's Concordance Index [C] = 0.85) was not inferior to the AJCC8 PS (AIC = 10,726.65; C = 0.84) for CSS, nor was the RSS (AIC = 14,714.4; C = 0.82) inferior to the AJCC8 PS (AIC = 14,784.69; C = 0.81) for OS.ConclusionThe RSS is comparable to the AJCC8 PS for a patient population receiving chemotherapy as well as endocrine- and HER2-targeted therapy and further stratifies stage IV patients.

Molecular Characterization and Mortality From Breast Cancer in Men.

Purpose Limited data exist on the molecular biology, treatment, and outcomes of breast cancer in men, and much of our understanding in this area remains largely an extrapolation from data in women with breast cancer. Materials and Methods We studied men and women with hormone receptor-positive breast cancer and the 21-gene Breast Recurrence Score (RS) results. Differences in clinical characteristics and gene expression were determined, and distribution of RS results was correlated with 5-year breast cancer-specific survival (BCSS) and overall survival. Results There were 3,806 men and 571,115 women. Men were older than women (mean age, 64.2 v 59.1 years; P < .001). RS < 18 predominated in both genders, but RS ≥ 31 was more frequent in men (12.4% v 7.4%; P < .001), as were very low scores (RS < 11; 33.8% v 22.1%; P < .001). Mean gene expression was higher in men for the estrogen receptor (ER), proliferation, and invasion groups. ER was lowest and progesterone receptor was highest in women younger than 50 years of age, with a progressive increase in ER with age. Men younger than 50 years of age had slightly lower ER and progesterone receptor compared with older men. Survival data were available from SEER for 322 men and 55,842 women. Five-year BCSS was 99.0% (95% CI, 99.3% to 99.9%) and 95.9% (95% CI, 87.6% to 98.7%) for men with RS < 18 and RS 18-30, respectively, and for women, it was 99.5% (95% CI, 99.4% to 99.6%) and 98.6% (95% CI, 98.4% to 98.8%), respectively. RS ≥ 31 was associated with an 81.0% 5-year BCSS in men (95% CI, 53.3% to 93.2%) and 94.9% 5-year BCSS (95% CI, 93.9% to 95.7%) in women. Five-year BCSS and overall survival were lower in men than in women. Conclusion This study reveals some distinctive biologic features of breast cancer in men and an important prognostic role for RS testing in both men and women.

Tumor Biology and Response to Chemotherapy Impact Breast Cancer-specific Survival in Node-positive Breast Cancer Patients Treated With Neoadjuvant Chemotherapy: Long-term Follow-up From ACOSOG Z1071 (Alliance).

Women with node-positive breast cancer are at high risk for recurrence. We evaluate the impact of approximated tumor subtype and response to chemotherapy on long-term outcomes in a node-positive cohort receiving neoadjuvant chemotherapy. ACOSOG Z1071 enrolled cT0-4N1-2 breast cancer patients treated with neoadjuvant chemotherapy from 2009 to 2011. Factors impacting breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed. Median follow-up of 701 eligible patients was 4.1 years (0.4-6.5). Ninety patients (12.8%) died from breast cancer. Approximated subtype and chemotherapy response were significantly associated with BCSS and OS (P < 0.0001). BCSS and OS were highest in patients who achieved pathologic complete response (pCR) (P < 0.0001 and P < 0.0001, respectively).Five-year BCSS was highest in human epidermal growth factor receptor 2 (HER2)-positive disease [95.8%; 95% confidence interval (CI): 87.7-98.6], followed by hormone receptor-positive/HER2-negative (80.4%; 95% CI: 73.2-85.9) and lowest in triple-negative (TNBC) (74.8%; 95% CI: 66.6-81.2; P < 0.0001). Similar patterns were seen in OS.In TNBC (n = 174), 5-year BCSS was higher in patients with pCR versus residual disease (89.8%; 95% CI: 78.8-95.3 vs 65.8%; 95% CI: 54.5-74.9; P = 0.0013). In hormone receptor-positive/HER2-negative (n = 318) disease, BCSS was 100% in patients with pCR and 78.3% (95% CI: 70.4-84.3) in those with residual disease (P = 0.018). In HER2-positive disease (n = 204) there was no difference between pCR and residual disease (96.0%; 95% CI: 83.6-99.1 vs 95.8%; 95% CI: 81.4-99.1; P = 0.77). In node-positive breast cancer patients treated with neoadjuvant chemotherapy, BCSS and OS were associated with approximated subtype and chemotherapy response and were lowest in TNBC patients with residual disease. Five-year BCSS was > 95% in HER2-positive disease independent of chemotherapy response.

Clinicopathological characteristics and survival outcomes of invasive lobular carcinoma in different races.

To investigate the clinicopathological characteristics and to determine whether there is a differential effect of race and examine survival outcomes according to race, 18,295 breast invasive lobular carcinoma (ILC) patients were identified in the Surveillance, Epidemiology, and End Result (SEER) database, which includes White patients (n=15,936), Black patients (n=1,451) and patients of other races (including American Indians/Alaskan Natives and Asian/Pacific Islanders) (n=908). The Black ILC patients presented a higher rate of advanced histological grades and American Joint Committee on Cancer (AJCC) stages, a higher rate of lymph node (LN) involvement and a lower rate of progesterone receptors (PR)-positivity than the White patients and other races. The five-year overall survival (OS) and five-year breast cancer specific survival (BCSS) were worst in the Black patients among these patients (85.5%, 76.0% and 87.7%, P<0.01; 91.1%, 84.4% and 91.6%, P<0.01). Multivariate regression analyses were performed to determine the risk hazards ratios (HR) of death for patients of the White, Black and other races. Among these patients, the Black patients had the worst survival outcomes in five-year OS and BCSS outcomes (HR=1.35, 95% confidence interval (CI) :1.20-1.51, P<0.01; HR=1.39, 95%CI:1.21-1.61, P<0.01, respectively). After a 1:1:1 matching of the three groups, the Black patients still presented worse survival outcomes in BCSS compared to White patients (HR=1.88, 95%CI: 1.14-3.10, P=0.013), however, there was no difference in OS (HR=1.35, 95%CI: 0.93-1.96, P=0.111). Difference in outcomes may partially explained by difference in histological grades, AJCC stage, LN and PR status among the three groups. In conclusion, this study revealed that the Black patients had worse five-year OS and BCSS than White and other race patients.

Impact of the 21-gene recurrence score on outcome in patients with invasive lobular carcinoma of the breast.

Invasive lobular carcinoma (ILC) of the breast has unique clinicopathologic characteristics, compared to invasive ductal carcinoma. The role of the 21-gene Recurrence Score (RS) has not been clearly defined for ILC. We sought to determine the prognostic value of RS and the impact of adjuvant chemotherapy on long-term survival in patients with ILC. Utilizing the Surveillance, Epidemiology and End Results database from 2004 to 2013, we identified records of women aged 18-74years, diagnosed with estrogen receptor (ER)-positive ILC (stage I to III) with RS available. We categorized patients into risk groups based on the traditional RS cutoffs and into those of the Trial Assigning Individualized Options for Treatment (TAILORx). Five-year breast cancer-specific survival (BCSS) was analyzed using the Kaplan-Meier method and Cox proportional hazards models. Of the 7316 women included, 21% were in the low-risk; 71%, intermediate-risk; and 8%, high-risk groups as per TAILORx RS cutoffs. The 5-year BCSS was 99% in the low-risk, 99% in the intermediate-risk, and 96% in the high-risk groups. A high-risk RS as per TAILORx cutoff was independently associated with increased mortality (hazard ratio [HR] of death 2.37, 95% confidence interval [CI] 1.14-4.95) when compared to a low-risk RS. In both the high-risk and intermediate-risk groups, adjuvant chemotherapy was not significantly associated with the HR of death (high-risk, HR 1.14, 95% CI 0.55-2.38; intermediate-risk, HR 1.08, 95% CI 0.62-1.87). For patients with ER-positive ILC, 8% were in the high-risk and 72% were in the intermediate-risk groups as per the TAILORx RS cutoffs. In the high-risk group, the RS predicted a lower 5-year BCSS. Adjuvant chemotherapy did not seem to confer a survival benefit for either the intermediate- or the high-risk cohorts.

Incorporating Tumor Characteristics to the American Joint Committee on Cancer Breast Cancer Staging System.

The American Joint Committee on Cancer (AJCC) breast cancer staging system provides important prognostic information. The recently published eighth edition incorporates biological markers and recommends the use of a complex "prognostic stage." In this study, we assessed the relationship between stage, breast cancer subtype, grade, and outcome in a large population-based cohort and evaluated a risk score system incorporating tumor characteristic to the AJCC anatomic staging system. Patients diagnosed with primary breast cancer stage I-IV between 2005-2008 were identified in the California Cancer Registry. For patients with stage I-III disease, pathologic stage was recorded. For patients with stage IV disease, clinical stage was utilized. Five-year breast cancer specific survival (BCSS) and overall survival (OS) rates were determined for each potential tumor size-node involvement-metastases (TNM) combination according to breast cancer subtype. A risk score point-based system using grade, estrogen receptor, and human epidermal growth factor receptor 2 (HER2) status was designed to complement the anatomic AJCC staging system. Survival probabilities between groups were compared using log-rank test. Cox proportional hazards models were used. Among 43,938 patients, we observed differences in 5-year BCSS and OS for each TNM combination according to breast cancer subtype. The most favorable outcomes were seen for hormone receptor-positive tumors followed closely by HER2-positive tumors, with the worst outcomes observed for triple negative breast cancer. Our risk score system separated patients into four risk groups within each stage category (all p < .05). Our simple risk score system incorporates biological factors into the AJCC anatomic staging system, providing accurate prognostic information. This study demonstrates that stage, but also breast cancer subtype and grade, define prognosis in a large population of breast cancer patients. It shows that a point-based risk score system that incorporates these biological factors provides refined stratification and information on prognosis, improving the anatomic American Joint Committee on Cancer (AJCC) staging system. In addition, the overall mortality and breast cancer specific mortality rates detailed here provide much-needed information about prognosis in the current era, refining the current AJCC staging.

Survival is Better After Breast Conserving Therapy than Mastectomy for Early Stage Breast Cancer: A Registry-Based Follow-up Study of Norwegian Women Primary Operated Between 1998 and 2008

BackgroundBreast-conserving therapy (BCT) and mastectomy (MTX) has been considered to have a similar long-time survival. However, better survival in women undergoing BCT compared with MTX is found in two recent register studies from the United States. The purpose of this study was to compare survival after BCT and MTX for women with early-stage breast cancer in Norway.MethodsWomen with invasive, early-stage breast cancer (1998–2008) where BCT and MTX were considered as equally beneficial treatments were included for a total of 13,015 women. Surgery was divided in two main cohorts (primary BCT, primary MTX) and five subcohorts. Analyses were stratified into T1N0M0, T2N0M0, T1N1M0, T2N1M0, and age groups (<50, 50–69, ≥70). Overall survival and breast cancer-specific survival (BCSS) were calculated in life tables, hazard ratios by Cox regression, and sensitivity analyses.ResultsFive-year BCSS for women who underwent primary BCT or primary MTX was 97 and 88 %, respectively. Women who underwent primary MTX had a hazard ratio of 1.64 (95 % confidence interval 1.43–1.88) for breast cancer death compared with women who underwent primary BCT after adjusting for the year of diagnosis, age at diagnosis, stage, histology, and grade.ConclusionsSurvival was better or equal after breast-conserving therapy than mastectomy in all early stages, surgical subcohorts, and age groups. This advantage could not only be attributed to differences in tumor biology.

Survival of patients with operable breast cancer (Stages I-III) at a Brazilian public hospital - a closer look into cause-specific mortality

BackgroundBreast cancer incidence is increasing. The survival rate varies and is longer in high-income countries. In Brazil, lower-income populations rely on the Unified Public Health System (Sistema Único de Saude, SUS) for breast cancer care. The goal of our study is to evaluate the survival of patients with operable breast cancer stages I-III at a Brazilian public hospital that treats mostly patients from the SUS.MethodsA cohort study of patients who underwent surgery for breast cancer treatment at the Clinical Hospital of the Federal University of Minas Gerais from 2001 to 2008 was performed, with a population of 897 cases. Information on tumor pathology and staging, as well as patients’ age and type of health coverage (SUS or private system) was collected. A probabilistic record linkage was performed with the database of the Mortality Information System to identify patients who died by December 31th, 2011. The basic cause of death was retrieved, and breast cancer-specific survival rates were estimated with the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis of factors related to survival.ResultsA total of 282 deaths occurred during the study’s period, 228 of them due to breast cancer. Five-year breast cancer-specific survival rates were 95.5% for stage I, 85.1% for stage II and 62.1% for stage III disease. Patients from the SUS had higher stages at diagnosis (42% was in stage III, and from the private system only 17.6% was in this stage), and in the univariate but not multivariate analysis, being treated by the SUS was associated with shorter survival (hazard ratio, HR = 2.22, 95% CI 1.24-3.98). In the multivariate analysis, larger tumor size, higher histologic grade, higher number of positive nodes and age older than 70 years were associated with a shorter breast cancer-specific survival.ConclusionsFive-year breast cancer survival was comparable to other Brazilian cohorts. Patients treated by the SUS, rather than by the private system, had shorter survival times, mostly due to higher initial stage of the disease.