Originally published as JCO Early Release 10.1200/JCO.2007.14.1168 on August 25 2008

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Trends in Survival Over the Past Two Decades Among White and Black Patients With Newly Diagnosed Stage IV Breast Cancer

Shaheenah Dawood, Kristine Broglio, Ana M. Gonzalez-Angulo, Aman U. Buzdar, Gabriel N. Hortobagyi, Sharon H. Giordano

From the Departments of Breast Medical Oncology and Quantitative Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Department of Medical Oncology, Dubai Hospital, United Arab Emirates

Corresponding author: Sharon Giordano, MD, MPH, 1515 Holcombe Blvd, Unit 1354, Houston, TX 77030-4009; e-mail: sgiordan{at}mdanderson.org

Purpose Overall, breast cancer mortality has been declining in the United States, but survival studies of patients with stage IV disease are limited. The aim of this study was to evaluate trends in and factors affecting survival in a large population-based cohort of patients with newly diagnosed stage IV breast cancer.

Patients and Methods We searched the Surveillance, Epidemiology, and End Results registry to identify female patients with stage IV breast cancer diagnosed between 1988 and 2003. Patients were divided into three groups according to year of diagnosis (1988 to 1993, 1994 to 1998, and 1999 to 2003). Survival outcomes were estimated by the Kaplan-Meier method, and Cox models were fit to determine the characteristics independently associated with survival.

Results We identified 15,438 patients. Median age was 62 years. Median follow-up was 16 months, 18 months, and 11 months in periods 1988 to 1993, 1994 to 1998, and 1999 to 2003, respectively. Median breast cancer–specific survival was 23 months. In the multivariate model, earlier year of diagnosis, grade 3 disease, increasing age, being unmarried, hormone receptor–negative disease, and no surgery were all independently associated with worse overall and breast cancer–specific survival. With each successive year of diagnosis, black patients had an increasingly greater risk of death compared with white patients (hazard ratio, 1.03; 95% CI, 1.00 to 1.06; P = .031).

Conclusion The survival of patients with newly diagnosed stage IV breast cancer has modestly improved over time, but these data suggest that the disparity in survival between black and white patients has increased.

published online ahead of print at www.jco.org on August 25, 2008

Supported in part by Grant No. 1K07 CA 109064-03 from the National Institutes of Health. The funding sources had no role in the study design, conduct, data analysis, or manuscript preparation.

Presented in part at the 43rd Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, June 1-6, 2007.

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

Clinical trial information can be found for the following: 1K07 CA 109064-03

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