title: Comparison of breast cancer recurrence and outcome patterns between patients treated from 1986 to 1992 and from 2004 to 2008.
abstract: OBJECTIVE
  To determine whether the patterns of relapse according to estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status changed in the contemporary era.
  
  
  METHODS
  Female patients referred to the British Columbia Cancer Agency with biopsy-proven stage I to III breast cancer (BC), diagnosed between 1986 and 1992 (cohort 1 [C1]) and between mid-2004 and 2008 (cohort 2 [C2]), and with known ER and HER2 status were eligible. Data were prospectively collected. C2 patients were matched to C1 patients for stage, grade, and ER and HER2 status. The primary end point was hazard rate of relapse (HRR) for BC by study cohort according to biomarker status. Secondary outcomes included HRR according to stage, grade, and age and hazard rate of death (HRD).
  
  
  RESULTS
  After matching, 7,178 patients were included (3,589 patients in each cohort). BC subtype distribution was as following ER positive/HER2 negative, 70.8%; ER positive/HER2 positive, 6.9%; ER negative/HER2 positive, 6.6%; and ER negative/HER2 negative, 15.8%. For the overall population, the HRR approximately halved in all yearly intervals to year 9 in C2 compared with C1. Differences in HRR between cohorts were greater in the initial five intervals for HER2-positive and ER-negative/HER2-negative BC. The HRR decreased in C2 compared with C1 for all disease stages and grades. The HRD in C2 also decreased compared with C1, although to a lesser extent.
  
  
  CONCLUSIONS
  Although the pattern of relapse remains similar, there has been a significant improvement in BC relapse-free survival. Outcomes have improved for all BC subtypes, especially HER2-positive and ER-negative/HER2-negative BC, with the early spike in disease recurrence markedly decreased. These contemporary hazard rates are important for treatment decisions, patient discussions, and planning clinical trials of early BC.
authors.affiliation: All authors: Vancouver Cancer Centre, Vancouver, British Columbia, Canada.
authors.forename: Rachel J D
authors.initials: RJ
authors.lastname: Cossetti
authors.affiliation: All authors: Vancouver Cancer Centre, Vancouver, British Columbia, Canada.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Tyldesley
authors.affiliation: All authors: Vancouver Cancer Centre, Vancouver, British Columbia, Canada.
authors.forename: Caroline H
authors.initials: CH
authors.lastname: Speers
authors.affiliation: All authors: Vancouver Cancer Centre, Vancouver, British Columbia, Canada.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: All authors: Vancouver Cancer Centre, Vancouver, British Columbia, Canada. kgelmon@bccancer.bc.ca.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Gelmon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000532:radiotherapy; D059248:Chemoradiotherapy / Q000379:methods; D015331:Cohort Studies; D018572:Disease-Free Survival; D004358:Drug Therapy / Q000379:methods* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000379:methods*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D013629:Tamoxifen / Q000008:administration & dosage / Q000627:therapeutic use; D043823:Taxoids / Q000008:administration & dosage; D000068878:Trastuzumab; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D047072:Aromatase Inhibitors; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D013629:Tamoxifen; D043823:Taxoids; D000068878:Trastuzumab