Impact of subtypes and comorbidities on breast cancer relapse and survival in population-based studies |
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| Affiliation: | 1. Cancer Registry St. Gallen-Appenzell, Cancer League Eastern Switzerland, St. Gallen, Krebsregister St.Gallen - Appenzell. Flurhofstr. 7, 9001 St. Gallen, Switzerland;2. Swiss Tropical and Public Health Institute, Basel, Krebsregister St.Gallen - Appenzell. Flurhofstr. 7, 9001 St. Gallen, Switzerland;3. Geneva Cancer Registry, University of Geneva, Magnin Registre genevois de tumeurs Rue Michel Servet 1, 1211 Geneve, Switzerland;4. Valais Cancer Registry, Observatoire valaisan de la santé, Sion, Registre valaisan de tumeurs, Avenue Grand-Champsec 64, 1950 Sion, Switzerland;5. Ticino Cancer Registry, Registro tumori del Ticino Via in Selva 24, 6601, Locarno, Switzerland;6. Cancer Registry of the Canton Zurich and Zug, University of Zurich, Krebsregister der Kantone Zürich und Zug Vogelsangstr. 10, 8091 Zürich, Switzerland;7. Institute for Pathology, Kantonsspital St. Gallen, Institut für Pathologie. Rorschacher Strasse 95, 9007 St.Gallen, Switzerland;8. Breast Cancer Centre, Kantonsspital St. Gallen, Brustzentrum St. Gallen. Rorschacher Strasse 95, 9007 St.Gallen, Switzerland;1. Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, OH;2. Department of Public Health, East Carolina University, Greenville, NC;3. Division of Medical Oncology, Department of Medicine, East Carolina University, Greenville, NC;4. Department of Radiation Oncology, University of North Carolina, Chapel Hill, Chapel Hill, NC;5. Department of Radiation Oncology, Mayo Clinic, Rochester, MN;6. Center for Health Disparities, Brody School of Medicine and Office of Research, College of Nursing, East Carolina University, Greenville, NC;1. Department of Pharmacy Practice and Science, College of Pharmacy, Iowa City, IA;2. Department of Epidemiology, College of Public Health, Iowa City, IA;3. Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, Iowa City, IA;1. Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China;2. Clinical Research Center for Breast Diseases, West China Hospital, Sichuan University, Chengdu, China;1. Hematology-Oncology Fellowship Program, Mayo Clinic, Rochester, MN;2. Nancy and James Grosfeld Cancer Genetics Center, Beaumont Cancer Institute, Beaumont Health, Royal Oak, MI;3. Department of Internal Medicine, Beaumont Health, Royal Oak, MI;4. Department of Internal Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH;5. Hematology-Oncology Fellowship Program, University of Texas MD Anderson Cancer Center, Houston, TX;6. Department of Internal Medicine, University of Cincinnati, Cincinnati, OH;7. Division of Hematology and Oncology, Department of Medicine, Michigan State University College of Human Medicine, East Lansing, MI;8. Oakland University William Beaumont School of Medicine, Rochester, MI |
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| Abstract: | ObjectiveTo study the impact of subtypes and comorbidities on breast cancer (BC) relapse and survival in the heterogeneous patients of the real world.MethodsWe identified patients diagnosed with BC between January 2003 and December 2005 from six population-based Swiss cancer registries. Clinicopathologic data was completed with information on locoregional and distant relapse and date and cause of death for over 10-years. We approximated BC subtypes using grade and the immunohistochemical panel for oestrogen, progesterone and human epidermal growth factor 2 (HER2) receptor status. We studied factors affecting relapse and survival.ResultsLuminal A-like subtype represented 46% of all newly diagnosed BC (N = 1831), followed by luminal B-like (N = 1504, 38%), triple negative (N = 436, 11%) and HER2 enriched (N = 204, 5%). We observed regional disparities in subtype prevalence that contribute to explain regional differences in survival formerly described. Disease relapse and BC specific mortality differed by subtype and were lower for luminal A like tumours than for other subtypes for any stage at diagnosis. After a median follow-up of 10.9 years, 1311 (33%) had died, half of them 647 (16%) due to another disease, showing the importance of comorbidities. Omission of systemic therapies in selected patients was not associated with poorer BC specific survival, BC subtype and life expectancy playing a role.ConclusionsInformation on tumour subtype is necessary for an adequate interpretation of population-based BC studies. Measures of comorbidity or frailty help in the evaluation of quality of care in the highly heterogeneous patients of the real world. |
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| Keywords: | Breast cancer subtypes Distant relapse Locoregional relapse Breast cancer survival Population-based study Switzerland |
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