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William J. Gradishar, MD, FACP, FASCO
William J. Gradishar, MD, FACP, FASCO
Posted: Tuesday, October 29, 2024
Lajos Pusztai, MD, DPhil, of Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, and colleagues reportedly conducted the first study evaluating annual trends in breast cancer–specific death by stage of disease at diagnosis. Published in the Journal of the National Cancer Institute, the results of this study suggest that more research is needed to identify and treat patients with stage I to II disease, since these cancers represent over 60% of annual breast cancer–specific deaths since 2017. This large contribution of low prognostic risk breast cancers to breast cancer death is the result of the large number of stage I and II cancers diagnosed each year and the rapidly declining recurrence rates in stage III and high-risk stage II breast cancers, which contribute less and less to annual breast cancer death.
“The contribution of death from breast cancer to all-cause mortality decreased in all stages and receptor subtypes over time, which is consistent with overall improvements in breast cancer mortality since 2000,” the researchers mentioned. “This trend will likely continue for stages II and III cancers due to continued improvements in efficacy of adjuvant therapies, although no similar improvements are seen in stage I breast cancers.”
The investigators collected data from the Surveillance, Epidemiology, and End Results (SEER) Program spanning from 1975 to 2017. The final analysis included 972,763 individuals after refining for one primary tumor type, surgery, stage I or higher according to the American Joint Committee on Cancer, female sex at birth, survival data available, and no bilateral cancer.
From 2000 to 2017, the contribution of stage I cancers to annual breast cancer–specific death increased significantly (16.2% to 23.1%). This was also true for stage II cancers, with the breast cancer–specific death rate rising from 30.7% to 39.5% in this timeframe. Of note, breast cancer–specific deaths from stage III and IV cancers decreased from 36.4% to 30.3% and from 16.7% to 7.1%, respectively.
T1a, T1b, and T1c node-negative cancers contributed to 0.92%, 4.0%, and 10.7% of breast cancer–specific deaths in 2000, respectively, growing significantly to 1.9%, 5.8%, and 14.7% by 2017. The investigators concluded: “Patients with stage I/II breast cancers have excellent prognosis, yet these cancers account for over 60% of current breast cancer–specific deaths because of their large absolute numbers. To further reduce breast cancer death, strategies are needed to identify and treat patients with stage I/II disease who remain at risk for recurrence.”
Disclosure: For full disclosures of the study authors, visit academic.oup.com.
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