Study estimates probability of death after breast cancer diagnosis

Women who are diagnosed with breast cancer are more likely to die from that cancer than from all other causes of death combined if they are diagnosed with advanced stages of disease at any age or with less advanced stages of disease at a young age, according to a new study in the September 1 issue of the Journal of the National Cancer Institute.

The chance of dying from breast cancer varies depending on the stage of the disease, the patient's age at diagnosis, other diseases and conditions a patient may have, and other factors. These probabilities are important pieces of information when weighing the risks and benefits of various treatment options, particularly in older patients who may have other health problems, and are also useful in comparisons across racial and age groups.

To develop better estimates of the risk of death from breast cancer and other causes in breast cancer patients, Catherine Schairer, Ph.D., of the National Cancer Institute, and colleagues analyzed data from the Surveillance, Epidemiology, and End Results (SEER) Program from more than 400,000 breast cancer patients diagnosed between 1973 and 2000. They calculated probabilities of death from breast cancer and all other causes combined over a 28-year follow-up period according to age at diagnosis, stage of disease, and race. More recently available data allowed further analysis over an 11-year follow-up period according to tumor size and estrogen receptor (ER) status.

The probability of death from breast cancer varied substantially according to stage, tumor size, estrogen receptor status, and age at diagnosis in both blacks and whites. For all stages of breast cancer, the probability of dying from breast cancer generally declined with age of diagnosis. However, it increased with advancing stage of disease at diagnosis for all ages. In addition, breast cancer patients with ER-negative tumors were more likely to die from their cancer than those with ER-positive tumors.

The researchers also found that the probability of dying from breast cancer was generally higher in blacks than in whites, even after accounting for any differences in age, disease stage at diagnosis, and ER status. They suggest that this higher probability may be due to differences in treatment, differences in prognostic factors within disease stages between blacks and whites, and a higher prevalence of obesity and obesity-related health conditions among black patients.

"To our knowledge, this is the first comprehensive competing-risk analysis to quantify the probability of death from breast cancer and other causes after a diagnosis of breast cancer," the authors write. "[T]he probability of death from breast cancer relative to the probability of death from other causes generally declined with age within stage and increased with advancing stage of disease, regardless of age, in both white and black patients. … Finally, the probability of death from breast cancer or other causes in black patients frequently exceeded that in white patients."

Contact: National Cancer Institute Press Office, 301-496-6641, NCIPressofficers@mail.nih.gov

Citation: Schairer C, Mink PJ, Carroll L, Devesa SS. Probabilities of Death From Breast Cancer and Other Causes Among Female Breast Cancer Patients. J Natl Cancer Inst 2004;96:1311–1321.

Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage. Visit the Journal online at http://jncicancerspectrum.oupjournals.org/.

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