Originally published as JCO Early Release 10.1200/JCO.2006.09.2106 on April 2 2007

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Breast Cancer Mortality Trends in the United States According to Estrogen Receptor Status and Age at Diagnosis

Ismail Jatoi, Bingshu E. Chen, William F. Anderson, Philip S. Rosenberg

From the Department of Surgery, National Naval Medical Center and Uniformed Services, University of the Health Sciences, Bethesda; and the Biostatistics Branch, Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Rockville, MD

Address reprint requests to Ismail Jatoi, MD, PhD, Director of Breast Care Center, Department of Surgery, National Naval Medical Center and Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; e-mail: ismail.jatoi{at}us.army.mil

Purpose Since 1990, overall breast cancer mortality rates in the United States decreased 24%. This decline has been attributed to mammography screening and adjuvant systemic therapy. However, the efficacy of these modalities may depend on estrogen receptor (ER) expression and age. We therefore examined breast cancer mortality trends in the United States according to ER status and age.

Methods Using the Surveillance, Epidemiology, and End Results (SEER) program (1990-2003), we calculated trends in incidence-based mortality (IBM), annual hazard rates for breast cancer deaths after diagnosis, and relative hazard rates for women with ER-positive and ER-negative tumors. Relative hazard rates were assessed with Cox proportional hazards models, adjusted for stage and grade, and stratified by age at diagnosis.

Results During the study period, IBM and annual hazard rates for breast cancer deaths decreased among women with ER-positive and ER-negative tumors, although declines were greater for those with ER-positive tumors. Among women younger than 70 years, relative hazard rates declined 38% for those with ER-positive tumors versus 19% for those with ER-negative tumors. Among women 70 years or older, relative hazard rates declined 14% for those with ER-positive tumors versus no significant decline for those with ER-negative tumors.

Conclusion In the United States, breast cancer mortality rates have declined among women with ER-positive and ER-negative tumors, with greater declines among younger women and those with ER-positive tumors. Although mortality in all groups remains unacceptably high, additional emphasis should be placed on improving outcomes of breast cancer patients older than 70 years and those of all ages with ER-negative tumors.

published online ahead of print at www.jco.org on April 2, 2007.

Supported in part by the intramural research program of the National Institutes of Health and the National Cancer Institute.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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