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A new method to extract information on the risk of recurrence in women with early-stage breast cancer should help oncologists to calculate the time it will take before they get to the clinic. a patient develops a metastatic disease, depending on her age and stage of diagnosis, reveal new research.
"Recurrence or progression to metastatic disease is a very important intermediate outcome before death that has not yet been quantified," said Angela Mariotto, PhD, chief of the Data Analytics Branch. of the National Cancer Institute, in Bethesda, Maryland. Medscape Medical News.
"And for cancer patients, the risk of progression to metastatic disease is a major concern," she added.
"It is therefore important to know the risks of progression to metastatic breast cancer for patients to decide on their treatment, as well as for experts in cancer control who identify research priorities and health service planning." said Mariotto in a statement.
The study was published online on October 18 in Cancer epidemiology, biomarkers and prevention.
The study cohort included women diagnosed with invasive breast cancer from 1992 to 2013. The data are from the Surveillance, Epidemiology and End Results database. The last cohort was 381,430 women.
Investigators estimated the risk of recurrence by using the cancer-specific disease-specific survival probabilities for each combination of stage, hormone receptor (HR) status, and time period during which a patient was diagnosed ( 1992-1999 and 2000-2013) and the age of the patient at the initial age. time of diagnosis (15 to 59 years, 60 to 74 years or 75 to 84 years).
"The risk of recurrence in 5, 10 or 15 years is lower in the more recent years of diagnosis and in the case of less advanced disease, HR + tumors and younger at the time of diagnosis," say Mariotto and his colleagues. colleagues.
"By aggregating data for all HR stages and statuses, our most recent estimates suggest that 20% of women diagnosed with stage I breast cancer will progress to MBC. [metastatic breast cancer] within 20 years of diagnosis, "they write.
In general, the risk of recurrence is higher in the first five years after diagnosis and is lower in women with no evidence of recurrence 5 and 10 years after breast cancer diagnosis.
Table. Percentage of women progressing to metastatic recurrence by year of diagnosis and stage of illness
| Positive HR | HR negative | |||||
|---|---|---|---|---|---|---|
| 15 to 59 years (%) | 60 to 74 years (%) | 75 to 84 years (%) | 15 to 59 years (%) | 60 to 74 years (%) | 75 to 84 years (%) | |
| Stage I: 2000 – 2013, 0 to 5 years from Dx | 2.3 | 2.5 | 4.5 | 7.2 | 6.5 | 10.3 |
| Step II: 2000 – 2013, 0 to 5 years from Dx | 9.3 | 9.6 | 14.1 | 18.2 | 20.2 | 28.1 |
| Step III: 2000 – 2013, 0 to 5 years from Dx | 32.1 | 34.5 | 42.3 | 47.8 | 48.5 | 60.6 |
Short explanation
In a brief explanation of how they arrived at their model, Mariotto gave an example using the equation A = B + C. If researchers know what C and A are, she said, they can then estimate B.
"A is the delay between diagnosis and death, B the delay between diagnosis and metastasis, and C is the delay between metastasis and death," she explained.
"We estimated B with the help of published studies on cohorts of patients with recurrent metastatic breast cancer (A and C)," Mariotto said.
The study authors point out that the lower risk of recurrence observed in women diagnosed with breast cancer in later periods probably reflects the benefits of using new treatments, such as taxanes and aromatase inhibitors.
The researchers were unable to include the HER2 status as a predictor in their analysis because the registers only contained this information recently.
The widespread adoption of trastuzumab for HER2-positive early-stage tumors has undoubtedly helped to reduce the risk of recurrence seen later, Mariotto said.
"I think these are very general estimates, and they are not really suitable for individual patients, because doctors must consider many other factors when estimating the risk of recurrence, including the patient's HER2 status. and other comorbidities, not taken into account in our estimates, "warned Mariotto.
"But these data provide a rough estimate of the risk of recurrence, and we continue to apply the same method to other types of cancer, including colorectal cancer," she said.
The study was sponsored by the National Cancer Institute. Dr. Mariotto did not reveal any relevant financial relationship.
Biomarkers of Epidemiological Cancer Prev. Posted online 18 October 2018. Summary
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