Time trends in incidence rates and survival of newly diagnosed stage IV breast cancer by tumor histology: a population-based analysis.
Few contemporary data are available that compare incidence and survival of metastatic breast cancer between ductal and lobular carcinomas. Using the Surveillance, Epidemiology, and End Results-9 registries, we identified 10,639 patients with de novo metastatic breast cancer diagnosed from 1990 to 2011. Annual age-adjusted incidence rates and annual percent changes (APCs) were analyzed. Multivariable Cox regression models were used to investigate the impact of year of diagnosis and histology on overall survival. 9250 (86.9 %) patients had ductal and 1389 (13.1 %) had lobular carcinomas. Metastatic breast cancer incidence increased slightly over time for ductal (APC = +1.7, 95 % confidence interval (CI) = +1.0 to +2.4) and lobular carcinomas (APC = +3.0, 95 % CI = +1.8 to +4.3). Median overall survival was 22 months among the whole cohort. More recent year of diagnosis was associated with better overall survival only for patients with ductal carcinomas (interaction p value = 0.006), with an adjusted hazard ratio of death for every five-year increment in the date of diagnosis of 0.93 (95 % CI =  0.91-0.95) among ductal carcinomas, compared with 1.05 (95 % CI = 0.95-1.10) among lobular carcinomas. Overall survival was longer for lobular versus ductal carcinomas (28 versus 21 months, respectively; adjusted hazard ratio of death = 0.93, 95 % CI = 0.87-0.99), but the magnitude of this effect was attenuated among the cohort restricted to hormone receptor-positive tumors. In this population-based analysis, incidence rates of metastatic breast cancer at presentation increased slightly over time for both histologies, and particularly for lobular tumors. A modest improvement in metastatic breast cancer median overall survival was observed, but was apparently limited to ductal carcinomas.
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.|Academic Unit of Medical Oncology, IRCCS AOU San Martino University Hospital, IST National Cancer Research Institute, Genoa, Italy.
Antonio
A
Di Meglio
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
Rachel A
RA
Freedman
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
Nancy U
NU
Lin
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
William T
WT
Barry
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
Otto
O
Metzger-Filho
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.|Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Nancy L
NL
Keating
Department of Surgical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, USA.
Tari A
TA
King
Academic Unit of Medical Oncology, IRCCS AOU San Martino University Hospital, IST National Cancer Research Institute, Genoa, Italy.
Mario Roberto
MR
Sertoli
Academic Unit of Medical Oncology, IRCCS AOU San Martino University Hospital, IST National Cancer Research Institute, Genoa, Italy.
Francesco
F
Boccardo
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
Eric P
EP
Winer
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA. InesV_Luis@dfci.harvard.edu.
Ines
0000-0002-7194-2260
I
Vaz-Luis
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology*; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology*; D018275:Carcinoma, Lobular / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Incidence; Invasive ductal carcinoma; Invasive lobular carcinoma; Metastatic breast cancer; Survival