Time trends in incidence rates and survival of newly diagnosed stage IV breast cancer by tumor histology: a population-based analysis
Few contemporary data are available that compare incidence and survival of metastatic breast cancer between ductal and lobular carcinomas. Using the Surveillance, Epidemiology, and End Results-9 registries, we identified 10,639 patients with de novo metastatic breast cancer diagnosed from 1990 to 2011. Annual age-adjusted incidence rates and annual percent changes (APCs) were analyzed. Multivariable Cox regression models were used to investigate the impact of year of diagnosis and histology on overall survival. 9250 (86.9 %) patients had ductal and 1389 (13.1 %) had lobular carcinomas. Metastatic breast cancer incidence increased slightly over time for ductal (APC = +1.7, 95 % confidence interval (CI) = +1.0 to +2.4) and lobular carcinomas (APC = +3.0, 95 % CI = +1.8 to +4.3). Median overall survival was 22 months among the whole cohort. More recent year of diagnosis was associated with better overall survival only for patients with ductal carcinomas (interaction p value = 0.006), with an adjusted hazard ratio of death for every five-year increment in the date of diagnosis of 0.93 (95 % CI = 0.91–0.95) among ductal carcinomas, compared with 1.05 (95 % CI = 0.95–1.10) among lobular carcinomas. Overall survival was longer for lobular versus ductal carcinomas (28 versus 21 months, respectively; adjusted hazard ratio of death = 0.93, 95 % CI = 0.87–0.99), but the magnitude of this effect was attenuated among the cohort restricted to hormone receptor-positive tumors. In this population-based analysis, incidence rates of metastatic breast cancer at presentation increased slightly over time for both histologies, and particularly for lobular tumors. A modest improvement in metastatic breast cancer median overall survival was observed, but was apparently limited to ductal carcinomas.
KeywordsMetastatic breast cancer Incidence Survival Invasive ductal carcinoma Invasive lobular carcinoma
This study used the Surveillance, Epidemiology, and End Results (SEER) database. The interpretation and reporting of these data are the sole responsibility of the authors. We thank Joyce Lii for her programming expertise, and the SEER*Stat Technical Support Team for their help with the incidence data used for the present study. The study was supported by Fundacao para a Ciencia e Tecnologia (HMSP-ICS/0004/2011, Career Development Award) (to Ines Vaz-Luis) and Dana–Farber Cancer Institute Friends Grant (to Ines Vaz-Luis).
Compliance with ethical standards
Conflict of interest
Rachel A. Freedman received institutional funding from Eisai, Genetech, and Puma Biotech. All the remaining authors have declared no conflict of interest.
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