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Staging Reclassification Affects Breast Cancer Survival

Breast Cancer Outcomes Unit, B.C. Cancer Agency and University of British Columbia, Victoria, British Columbia, Canada

To the Editor: We read with interest the observation of the "Will Rogers" phenomenon described by Woodward et al¹ in their institutional series of 1,350 patients with mainly node-positive breast cancer treated with anthracycline chemotherapy at the University of Texas M.D. Anderson Cancer Center. We have examined the effect of changes in the sixth edition of the 2003 American Joint Committee on Cancer (AJCC) staging system,² in a population-based series of 12,125 patients with newly diagnosed breast cancer referred to one of four BC Cancer Agency Centres in British Columbia, Canada, from 1989 to 1997. Our observations confirm those of Woodward et al and demonstrate applicability to the general population of patients with breast cancer.

The 2003 AJCC staging classification changes dependent on the number of involved nodes had the most dramatic effect. Compared to the AJCC fifth edition classification, nodal stage in the 2003 version separates patients with nodal involvement more reliably into prognostic groups (Fig 1). Our data confirm that the staging reclassifications effectively improves survival for N₁, N₂, and N₃ subgroups. The overall effect on survival by stage is less dramatic (Fig 2). Our population-based data demonstrate modest improvements to prognosis for patients with stage II and III breast cancer but no noticeable change for women with stage I or IV breast cancer. These observations have important implications for the design and reporting of clinical research and in communicating prognosis to patients.

View larger version (13K): [in this window] [in a new window]   Fig 1. Ten-year prognosis according to nodal stage according to the American Joint Committee on Cancer tumor-node-metastasis system classification of breast tumors fifth edition (A; 1988) and sixth edition (B; 2003).

View larger version (13K): [in this window] [in a new window]   Fig 2. Ten-year prognosis according to overall stage according to the American Joint Committee on Cancer tumor-node-metastasis system classification of breast tumors fifth edition (A; 1988) and sixth edition (B; 2003).

The authors indicated no potential conflicts of interest.

REFERENCES

1. Woodward WA, Strom EA, Tucker SL, et al: Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stage-specific survival. J Clin Oncol 21:3244–3248, 2003[Abstract/Free Full Text]

2. Singletary SE, Allred C, Ashley P, et al: Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 20:3628–3636, 2002[Abstract/Free Full Text]

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