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P118 Breast cancer mortality trends among white andblack women in the United States: an age-period-cohort analysis
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Poster Session II. Health Politics/Epidemiology/Guidelines
receptor was overexpressed in 15% of patients. Grade III tumor was seen in 34% of patients and lymphovascular invasion was present in 9%. 67% were operated as first therapeutic procedure, (32% lumpectomy only, 49% lumpectomy with axillary sampling and 19% mastectomy). 67% had T1,27% had T2 and 7% had T3 disease. 73% had NO disease. 77% of lumpectomy patients had post operative radiotherapy. 33% of patients were not operated due to poor medical condition or advanced disease. Clinically, 13% of this group of patients had T2 tumors, 6% T3, 7% T4 and 6% had metastatic disease at presentation. Hormonal therapy was the most widely used systemic treatment. 57% of patients received adjuvant hormonal therapy (45% tamoxi and 12% aromatase inhibitors), 26% received neoadjuvant hormonal therapy (5% tamoxi and 21% aromatase inhibitors) and 10% received palliative hormonal therapy (3% tamoxi and 7% aromatase inhibitors). Chemotherapy was given to only 5% of patients (3% adjuvant, 1% neoadjuvant and 1% palliative). We concluded that elderly breast cancer patients aged more than 75 years present with a similar stage distribution to younger population. The majority (80%) have hormone responsive disease. Local therapy by surgery and radiotherapy is less aggressive than in younger patients. Hormonal therapy is the main treatment in this subgroup and it is widely used in most clinical situations.
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Breast carcinoma - Biologic factors and treatment approach in age groups population
A. Rabkin 1, Z. Sklar 2, M. Steiner 3, M. Leviov4, S. Keren 5, R. Rubinov 6, K. Sinatzki 7. ~Lin Medical Center, Oncology, Haifa, Israel; 2 Carmel Hospital, Oncology, Haifa, Israel; 3 Lin Medical Center, Oncology, Haifa, Israel; 4 Lin Medical Center, Oncology, Haifa, Israel; 5 Lin Medical Center, Oncology, Haifa, Israel; 8 Lin Medical Center, Oncology, Haifa, Israel; 7 Lin Medical Center, Oncology, Haifa, Israel The clinical data of 690 consecutive breast cancer patients treated during the last three years was retrospectively examined. Patients were divided into two age groups, one consisting of 369 patients younger than 65 years (median 53, 29-65) and the second included 321 patients aged 65 years or more (median 74, 65-93). The biological and prognostic factors as well as treatment approach were compared. The majority of patients in the two groups had invasive ductal carcinoma but DCIS was more common in the younger group (11% vs 7%) and invasive Iobular carcinoma was more common in the older population (8% vs 4%). Grade III tumors were found in 37% of the younger patients and in 29% of the older ones. Lymphovascular and perineural invasion were also more common in the younger group (11% and 5% vs 7% and 4% respectively). 23% of younger patients had hormonal receptors negative compared to 12% of older patients. Her2neu overexpression was found in 17% of the younger patients and in 14% of the older ones. 82% of the younger and 79% of the older patients were operated as the first treatment procedure. Lumpectomy/Mastectomy rate was 76/24 and 83/17 respectively. T1 tumor was found in 70% of younger patients and in 73% of older ones. Node negative disease was found in 64% and 72% respectively. Post operative radiotherapy was administered to 87% of younger and 78% of older patients. Adjuvant chemotherapy was given in 43% and 11% respectively. 72% of the younger patients and 66% of the older ones received adjuvant hormonal therapy. 18% of younger patients had upfront systemic therapy 11% as neoadjuvant therapy and 7% due to locally advanced or metastatic disease. 21% of older patients had systemic therapy as first treatment, 12% for local disease (neoadjuvant or patients were not considered for surgery) and 9% for locally advanced or metastatic disease. We conclude that no major differences were found in the presentation, biological and prognostic factors and treatment approach between patients under or over 65 years. Younger patients tend to present with more aggressive and advanced tumors. Local therapy by surgery and radiotherapy is slightly less aggressive in older patients. Adjuvant chemotherapy is significantly more often administered to younger patients while hormonal therapy is the most common adjuvant therapy in both age groups.
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Breast cancer mortality trends among white and black women in the United States: an age-period-cohort analysis
I. Jatoi 1, W. Anderson 2 , S. Rao 3, S. Devesa 3. 1 Uniformed Services Universi~ Department of Surgery, Bethesda, United States of America; 2 National Cancer Institute, Division of Cancer Prevention, Bethesda, United States of America; 3 National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, United States of America
Background: Population-based statistics in the United States indicate that recent age-adjusted breast cancer mortality rates are higher for Blacks than for Whites. This racial disparity developed 25 years ago and has been widening ever since.
Friday, 28 January 2005 Purpose: To use age-period-cohort (APC) modeling to investigate why breast cancer mortality rates among Whites and Blacks are diverging. Variations in calendar period trends reflect, in part, the impact of new medical interventions, including access or response to those interventions, while alterations in birth cohort trends may suggest changes in risk or protective factors. Methods: U.S. female breast cancer mortality data from the National Center for Health Statistics were accessed via SEER*Stat. Rates for 1952-56 through 1997-2000 for whites, nonwhites, and blacks (since 1972) were ageadjusted using the 2000 U.S. standard and expressed per 100,000 womanyears. Age-period-cohort models using Poisson regression were fitted to the breast cancer mortality data using 5-year age and calendar period intervals. Identifiable differences in linear contrasts were used to examine changes in slopes of long-term linear trends for calendar-period and birth-cohort effects. Results: The calendar period model revealed declining breast cancer mortality risk for Whites over the entire time period. A similar trend was suggested for Blacks until the late 1970s, when there was a sharp increase in calendar period slope, which stabilized around 1994. After 1994, rates declined among all racial groups, with the sharpest decreases among Whites. The birth cohort model shows an increase in slope, indicating an increase in breast cancer mortality risk, for both racial groups for births extending from 1872 to about 1927, after which risk stabilizes. For women born after 1950, breast cancer mortality risk appears to have decreased more for Blacks than Whites. Conclusion: The overall increase in breast cancer mortality rates among Blacks during the late 1970s can largely be attributed to a period effect, which overshadowed the birth cohort trends. Recent declines in breast cancer mortality rates among both Blacks and Whites can be attributed to combined birth cohort and calendar period effects. However, in recent years, Whites have experienced greater declines in overall breast cancer mortality rates than Blacks, further widening the racial disparity in mortality. [P~
Characteristics and outcome of breast cancer in patients <35 years old
V. Gaki 1, N. Louvrou 1, D. Baltas 1, N. Bredakis ~, G. Vourli 1, C. Dimitrakakis ~, D. Keramopoullos ~, M. Bebi 1, J. Louis ~, A. Keramopoullos ~. I IASO women's Hospital, Breast Oncology, Athens, Greece
Introduction: Several studies report controversial results concerning the effect of age in breast cancer outcome (survival, disease free survival). In order to investigate this issue, we performed this retrospective study. Materials and methods: Between the years 1979 and 2004, 181 women aged 20-35 years old (31.64-3.4 years) have been treated in the breast oncology unit of IASO and Alexandra women's hospital. Patients' characteristics (grade, lymph nodes status, size, hormone receptors' status) and events related to the disease have been recorded. Differences between proportions are evaluated through the Pearson's chi-square test. Estimates of the survival rates are calculated through a Kaplan-Meier model and differences on the survival distribution are assessed by a log-rank test. Results: Median follow up time is 38 months (3-300 months). Six women (3.3%) had metastatic disease at the time of diagnosis. In 20 cases (11%) the tumor's grade was I, in 81 cases (44.8%) the tumor's grade was II and in 65 cases (35.9%) the tumor's grade was II1. Ninety-four cases (51.9%) were lymph node negative, while 87 cases (48.1%) were lymph node positive. The tumor's size was 1-20mm in 78 cases (43.1%), 21-50mm in 86 cases (47.5%) and more than 50mm in 11 cases (6.1%). Compared to a group of 927 women aged 36-48 years old (43.04-3.5 years), a greater proportion of young women had metastatic disease (p=0.045). None of the rest of the tumor's characteristics differs significantly. The 5 years survival rate for the first group (young women) is 77.5% and for the second group it is 86.9%. Moreover, the 5 years disease free survival rate for the first group is 73.1% and for the second group it is 82.8%. The difference of the survival distribution between the two groups is statistically significant for both the overall survival and the disease free survival (p=0.015, p=0.020 respectively). Conclusion: Our results suggest that women<35 years had more advanced disease at the time of diagnosis and a poorer 5-year survival compared with older patients.
Poster Session II. Health Politics/Epidemiology/Guidelines
receptor was overexpressed in 15% of patients. Grade III tumor was seen in 34% of patients and lymphovascular invasion was present in 9%. 67% were operated as first therapeutic procedure, (32% lumpectomy only, 49% lumpectomy with axillary sampling and 19% mastectomy). 67% had T1,27% had T2 and 7% had T3 disease. 73% had NO disease. 77% of lumpectomy patients had post operative radiotherapy. 33% of patients were not operated due to poor medical condition or advanced disease. Clinically, 13% of this group of patients had T2 tumors, 6% T3, 7% T4 and 6% had metastatic disease at presentation. Hormonal therapy was the most widely used systemic treatment. 57% of patients received adjuvant hormonal therapy (45% tamoxi and 12% aromatase inhibitors), 26% received neoadjuvant hormonal therapy (5% tamoxi and 21% aromatase inhibitors) and 10% received palliative hormonal therapy (3% tamoxi and 7% aromatase inhibitors). Chemotherapy was given to only 5% of patients (3% adjuvant, 1% neoadjuvant and 1% palliative). We concluded that elderly breast cancer patients aged more than 75 years present with a similar stage distribution to younger population. The majority (80%) have hormone responsive disease. Local therapy by surgery and radiotherapy is less aggressive than in younger patients. Hormonal therapy is the main treatment in this subgroup and it is widely used in most clinical situations.
~-~
Breast carcinoma - Biologic factors and treatment approach in age groups population
A. Rabkin 1, Z. Sklar 2, M. Steiner 3, M. Leviov4, S. Keren 5, R. Rubinov 6, K. Sinatzki 7. ~Lin Medical Center, Oncology, Haifa, Israel; 2 Carmel Hospital, Oncology, Haifa, Israel; 3 Lin Medical Center, Oncology, Haifa, Israel; 4 Lin Medical Center, Oncology, Haifa, Israel; 5 Lin Medical Center, Oncology, Haifa, Israel; 8 Lin Medical Center, Oncology, Haifa, Israel; 7 Lin Medical Center, Oncology, Haifa, Israel The clinical data of 690 consecutive breast cancer patients treated during the last three years was retrospectively examined. Patients were divided into two age groups, one consisting of 369 patients younger than 65 years (median 53, 29-65) and the second included 321 patients aged 65 years or more (median 74, 65-93). The biological and prognostic factors as well as treatment approach were compared. The majority of patients in the two groups had invasive ductal carcinoma but DCIS was more common in the younger group (11% vs 7%) and invasive Iobular carcinoma was more common in the older population (8% vs 4%). Grade III tumors were found in 37% of the younger patients and in 29% of the older ones. Lymphovascular and perineural invasion were also more common in the younger group (11% and 5% vs 7% and 4% respectively). 23% of younger patients had hormonal receptors negative compared to 12% of older patients. Her2neu overexpression was found in 17% of the younger patients and in 14% of the older ones. 82% of the younger and 79% of the older patients were operated as the first treatment procedure. Lumpectomy/Mastectomy rate was 76/24 and 83/17 respectively. T1 tumor was found in 70% of younger patients and in 73% of older ones. Node negative disease was found in 64% and 72% respectively. Post operative radiotherapy was administered to 87% of younger and 78% of older patients. Adjuvant chemotherapy was given in 43% and 11% respectively. 72% of the younger patients and 66% of the older ones received adjuvant hormonal therapy. 18% of younger patients had upfront systemic therapy 11% as neoadjuvant therapy and 7% due to locally advanced or metastatic disease. 21% of older patients had systemic therapy as first treatment, 12% for local disease (neoadjuvant or patients were not considered for surgery) and 9% for locally advanced or metastatic disease. We conclude that no major differences were found in the presentation, biological and prognostic factors and treatment approach between patients under or over 65 years. Younger patients tend to present with more aggressive and advanced tumors. Local therapy by surgery and radiotherapy is slightly less aggressive in older patients. Adjuvant chemotherapy is significantly more often administered to younger patients while hormonal therapy is the most common adjuvant therapy in both age groups.
•
Breast cancer mortality trends among white and black women in the United States: an age-period-cohort analysis
I. Jatoi 1, W. Anderson 2 , S. Rao 3, S. Devesa 3. 1 Uniformed Services Universi~ Department of Surgery, Bethesda, United States of America; 2 National Cancer Institute, Division of Cancer Prevention, Bethesda, United States of America; 3 National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, United States of America
Background: Population-based statistics in the United States indicate that recent age-adjusted breast cancer mortality rates are higher for Blacks than for Whites. This racial disparity developed 25 years ago and has been widening ever since.
Friday, 28 January 2005 Purpose: To use age-period-cohort (APC) modeling to investigate why breast cancer mortality rates among Whites and Blacks are diverging. Variations in calendar period trends reflect, in part, the impact of new medical interventions, including access or response to those interventions, while alterations in birth cohort trends may suggest changes in risk or protective factors. Methods: U.S. female breast cancer mortality data from the National Center for Health Statistics were accessed via SEER*Stat. Rates for 1952-56 through 1997-2000 for whites, nonwhites, and blacks (since 1972) were ageadjusted using the 2000 U.S. standard and expressed per 100,000 womanyears. Age-period-cohort models using Poisson regression were fitted to the breast cancer mortality data using 5-year age and calendar period intervals. Identifiable differences in linear contrasts were used to examine changes in slopes of long-term linear trends for calendar-period and birth-cohort effects. Results: The calendar period model revealed declining breast cancer mortality risk for Whites over the entire time period. A similar trend was suggested for Blacks until the late 1970s, when there was a sharp increase in calendar period slope, which stabilized around 1994. After 1994, rates declined among all racial groups, with the sharpest decreases among Whites. The birth cohort model shows an increase in slope, indicating an increase in breast cancer mortality risk, for both racial groups for births extending from 1872 to about 1927, after which risk stabilizes. For women born after 1950, breast cancer mortality risk appears to have decreased more for Blacks than Whites. Conclusion: The overall increase in breast cancer mortality rates among Blacks during the late 1970s can largely be attributed to a period effect, which overshadowed the birth cohort trends. Recent declines in breast cancer mortality rates among both Blacks and Whites can be attributed to combined birth cohort and calendar period effects. However, in recent years, Whites have experienced greater declines in overall breast cancer mortality rates than Blacks, further widening the racial disparity in mortality. [P~
Characteristics and outcome of breast cancer in patients <35 years old
V. Gaki 1, N. Louvrou 1, D. Baltas 1, N. Bredakis ~, G. Vourli 1, C. Dimitrakakis ~, D. Keramopoullos ~, M. Bebi 1, J. Louis ~, A. Keramopoullos ~. I IASO women's Hospital, Breast Oncology, Athens, Greece
Introduction: Several studies report controversial results concerning the effect of age in breast cancer outcome (survival, disease free survival). In order to investigate this issue, we performed this retrospective study. Materials and methods: Between the years 1979 and 2004, 181 women aged 20-35 years old (31.64-3.4 years) have been treated in the breast oncology unit of IASO and Alexandra women's hospital. Patients' characteristics (grade, lymph nodes status, size, hormone receptors' status) and events related to the disease have been recorded. Differences between proportions are evaluated through the Pearson's chi-square test. Estimates of the survival rates are calculated through a Kaplan-Meier model and differences on the survival distribution are assessed by a log-rank test. Results: Median follow up time is 38 months (3-300 months). Six women (3.3%) had metastatic disease at the time of diagnosis. In 20 cases (11%) the tumor's grade was I, in 81 cases (44.8%) the tumor's grade was II and in 65 cases (35.9%) the tumor's grade was II1. Ninety-four cases (51.9%) were lymph node negative, while 87 cases (48.1%) were lymph node positive. The tumor's size was 1-20mm in 78 cases (43.1%), 21-50mm in 86 cases (47.5%) and more than 50mm in 11 cases (6.1%). Compared to a group of 927 women aged 36-48 years old (43.04-3.5 years), a greater proportion of young women had metastatic disease (p=0.045). None of the rest of the tumor's characteristics differs significantly. The 5 years survival rate for the first group (young women) is 77.5% and for the second group it is 86.9%. Moreover, the 5 years disease free survival rate for the first group is 73.1% and for the second group it is 82.8%. The difference of the survival distribution between the two groups is statistically significant for both the overall survival and the disease free survival (p=0.015, p=0.020 respectively). Conclusion: Our results suggest that women<35 years had more advanced disease at the time of diagnosis and a poorer 5-year survival compared with older patients.