Long Term Risk of Distant Metastasis in Women with Non-metastatic Breast Cancer and Survival After Metastasis Detection: a Population-based Linked Health Records Study

Overview

Journal Med J Aust

Specialty General Medicine

Date 2022 Aug 20

PMID 35987521

Authors

Sarah Sally J Lord

Benjamin Daniels

Belinda E Kiely

Dianne L OConnell

Jane Beith

Sallie Pearson

Kim-Lin Chiew

Max K Bulsara

Nehmat Houssami

Affiliations

Soon will be listed here.

Abstract

Objectives: To estimate the long term risk of distant metastases (DM) for women with initial diagnoses of non-metastatic breast cancer; to estimate breast cancer-specific and overall survival for women with DM.

Design: Population-based health record linkage study.

Setting, Participants: Women diagnosed with localised or regional primary breast cancer recorded in the NSW Cancer Registry, 2001-2002.

Major Outcome Measures: Time from breast cancer diagnosis to first DM, time from first DM to death from breast cancer.

Secondary Outcome: time to death from any cause.

Results: 6338 women were diagnosed with non-metastatic breast cancer (localised, 3885; regional, 2453; median age, 59 years [IQR, 49-69 years]). DM were recorded (to 30 September 2016) for 1432 women (23%; median age, 62 years [IQR, 51-73 years]). The 14-year cumulative DM incidence was 22.2% (95% CI, 21.1-23.2%; localised disease: 14.3% [95% CI, 13.2-15.4%]; regional disease: 34.7% [95% CI, 32.8-36.6%]). Annual hazard of DM was highest during the second year after breast cancer diagnosis (localised disease: 2.8%; 95% CI, 2.3-3.3%; regional disease: 9.1%; 95% CI, 7.8-10.3%); from year five it was about 1% for those with localised disease, from year seven about 2% for women with regional disease at diagnosis. Five years after diagnosis, the 5-year conditional probability of DM was 4.4% (95% CI, 3.7-5.1%) for women with localised and 10.4% (95% CI, 9.1-12.0%) for those with regional disease at diagnosis. Median breast cancer-specific survival from first DM record date was 28 months (95% CI, 25-31 months); the annual hazard of breast cancer death after the first DM record declined from 36% (95% CI, 33-40%) during the first year to 14% (95% CI, 11-18%) during the fourth year since detection.

Conclusions: DM risk declines with time from diagnosis of non-metastatic breast cancer, and the annual risk of dying from breast cancer declines with time from initial DM detection. These findings can be used to inform patients at follow-up about changes in risk over time since diagnosis and for planning health services.

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References

Lord S, Marinovich M, Patterson J, Wilcken N, Kiely B, Gebski V . Incidence of metastatic breast cancer in an Australian population-based cohort of women with non-metastatic breast cancer at diagnosis. Med J Aust. 2012; 196(11):688-92. DOI: 10.5694/mja12.10026. View

. Trastuzumab for early-stage, HER2-positive breast cancer: a meta-analysis of 13 864 women in seven randomised trials. Lancet Oncol. 2021; 22(8):1139-1150. PMC: 8324484. DOI: 10.1016/S1470-2045(21)00288-6. View

Malmgren J, Mayer M, Atwood M, Kaplan H . Differential presentation and survival of de novo and recurrent metastatic breast cancer over time: 1990-2010. Breast Cancer Res Treat. 2017; 167(2):579-590. PMC: 5790843. DOI: 10.1007/s10549-017-4529-5. View

Hortobagyi G, Stemmer S, Burris H, Yap Y, Sonke G, Hart L . Overall Survival with Ribociclib plus Letrozole in Advanced Breast Cancer. N Engl J Med. 2022; 386(10):942-950. DOI: 10.1056/NEJMoa2114663. View

van Maaren M, Strobbe L, Smidt M, Moossdorff M, Poortmans P, Siesling S . Ten-year conditional recurrence risks and overall and relative survival for breast cancer patients in the Netherlands: Taking account of event-free years. Eur J Cancer. 2018; 102:82-94. DOI: 10.1016/j.ejca.2018.07.124. View

Daniels B, Kiely B, Lord S, Houssami N, Lu C, Ward R . Long-term survival in trastuzumab-treated patients with HER2-positive metastatic breast cancer: real-world outcomes and treatment patterns in a whole-of-population Australian cohort (2001-2016). Breast Cancer Res Treat. 2018; 171(1):151-159. DOI: 10.1007/s10549-018-4804-0. View

Lord S, Kiely B, Pearson S, Daniels B, OConnell D, Beith J . Metastatic breast cancer incidence, site and survival in Australia, 2001-2016: a population-based health record linkage study protocol. BMJ Open. 2019; 9(2):e026414. PMC: 6367965. DOI: 10.1136/bmjopen-2018-026414. View

Hawley S, Janz N, Griffith K, Jagsi R, Friese C, Kurian A . Recurrence risk perception and quality of life following treatment of breast cancer. Breast Cancer Res Treat. 2016; 161(3):557-565. PMC: 5310669. DOI: 10.1007/s10549-016-4082-7. View

Dent R, Trudeau M, Pritchard K, Hanna W, Kahn H, Sawka C . Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 2007; 13(15 Pt 1):4429-34. DOI: 10.1158/1078-0432.CCR-06-3045. View

10.

Kemp-Casey A, Roughead E, Saunders C, Boyle F, Lopez D, Bulsara M . Breast cancer recurrence following active treatment: determining its incidence in the NSW population. Public Health Res Pract. 2016; 26(1):e2611607. DOI: 10.17061/phrp2611607. View

11.

Lao C, Kuper-Hommel M, Elwood M, Campbell I, Lawrenson R . Metastatic relapse of stage I-III breast cancer in New Zealand. Cancer Causes Control. 2021; 32(7):753-761. DOI: 10.1007/s10552-021-01426-0. View

12.

Holleczek B, Stegmaier C, Radosa J, Solomayer E, Brenner H . Risk of loco-regional recurrence and distant metastases of patients with invasive breast cancer up to ten years after diagnosis - results from a registry-based study from Germany. BMC Cancer. 2019; 19(1):520. PMC: 6543576. DOI: 10.1186/s12885-019-5710-5. View

13.

Holzel D, Eckel R, Bauerfeind I, Baier B, Beck T, Braun M . Improved systemic treatment for early breast cancer improves cure rates, modifies metastatic pattern and shortens post-metastatic survival: 35-year results from the Munich Cancer Registry. J Cancer Res Clin Oncol. 2017; 143(9):1701-1712. DOI: 10.1007/s00432-017-2428-0. View

14.

Reddy S, Barcenas C, Sinha A, Hsu L, Moulder S, Tripathy D . Long-term survival outcomes of triple-receptor negative breast cancer survivors who are disease free at 5 years and relationship with low hormone receptor positivity. Br J Cancer. 2017; 118(1):17-23. PMC: 5765226. DOI: 10.1038/bjc.2017.379. View

15.

Pan H, Gray R, Braybrooke J, Davies C, Taylor C, McGale P . 20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years. N Engl J Med. 2017; 377(19):1836-1846. PMC: 5734609. DOI: 10.1056/NEJMoa1701830. View

16.

Stuart-Harris R, Dahlstrom J, Gupta R, Zhang Y, Craft P, Shadbolt B . Recurrence in early breast cancer: Analysis of data from 3,765 Australian women treated between 1997 and 2015. Breast. 2019; 44:153-159. DOI: 10.1016/j.breast.2019.02.004. View

17.

Lao C, Kuper-Hommel M, Elwood M, Campbell I, Edwards M, Lawrenson R . Characteristics and survival of de novo and recurrent metastatic breast cancer in New Zealand. Breast Cancer. 2020; 28(2):387-397. DOI: 10.1007/s12282-020-01171-3. View

18.

Lord S, Bahlmann K, OConnell D, Kiely B, Daniels B, Pearson S . and recurrent metastatic breast cancer - A systematic review of population-level changes in survival since 1995. EClinicalMedicine. 2022; 44:101282. PMC: 8804182. DOI: 10.1016/j.eclinm.2022.101282. View