Examination of a paradox: recurrent metastatic breast cancer incidence decline without improved distant disease survival: 1990–2011

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.

Optimizing Palbociclib Therapy Across the Age Spectrum: Hypothetical, Illustrative Case Scenarios in HR+, HER2– Metastatic Breast Cancer

“…Although generally well tolerated, the long-term efficacy of ET is limited by the emergence of endocrine resistance. Estrogen receptor–positive breast tumors have a risk of recurrence of approximately 2% per year ( Cadoo, Fornier, & Morris, 2013 ), and retrospective analyses indicate that about 60% of patients diagnosed with stage I to III HR+/HER2– breast cancer eventually experience distant metastatic recurrence ( Malmgren, Hurlbert, Atwood, & Kaplan, 2019 ).…”

Expression of TRPC1 and SBEM protein in breast cancer tissue and its relationship with clinicopathological features and prognosis of patients

“…Statistics show that the recurrence rate of breast cancer metastatic patients is high and the 5-year survival rate is low (7). Clinically, the etiology of breast cancer is not completely clear, so early diagnosis of breast cancer patients can be carried out to improve the survival rate (8).…”

Breast cancer distant recurrence lead time interval by detection method in an institutional cohort

“…The incidence of recurrent metastatic breast cancer (rMBC) and breast cancer mortality have decreased in recent years coincident with improvement in breast cancer survival due to both reduced incidence of higher stage disease related to mammography screening and improved adjuvant systemic therapy for invasive stage I-III disease [1][2][3][4]. Debate and analysis continue about the relative contribution of early detection of breast cancer by mammography screening to improved survival [5][6][7][8].…”