title: Trends in survival over the past two decades among white and black patients with newly diagnosed stage IV breast cancer.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Breast Medical Oncology and Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA.
authors: Shaheenah
authors: S
authors: Dawood
authors: Kristine
authors: K
authors: Broglio
authors: Ana M
authors: AM
authors: Gonzalez-Angulo
authors: Aman U
authors: AU
authors: Buzdar
authors: Gabriel N
authors: GN
authors: Hortobagyi
authors: Sharon H
authors: SH
authors: Giordano
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*