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Occurrence and outcome of de novo metastatic breast cancer by subtype in a large, diverse population

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Abstract

Purpose

To examine the occurrence and outcomes of de novo metastatic (Stage IV) breast cancer, particularly with respect to tumor HER2 expression.

Methods

We studied all 6,268 de novo metastatic breast cancer cases diagnosed from 1 January 2005 to 31 December 2011 and reported to the California Cancer Registry. Molecular subtypes were classified according to HER2 and hormone receptor (HR, including estrogen and/or progesterone receptor) expression. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) of Stage IV versus Stage I–III breast cancer; Cox proportional hazards regression was used to assess relative hazard (RH) of mortality.

Results

Five percent of invasive breast cancer was metastatic at diagnosis. Compared to patients with earlier stage disease, patients with de novo metastatic disease were significantly more likely to have HER2+ tumors (HR+/HER2+: OR 1.29, 95 % CI 1.17–1.42; HR−/HER2+: OR 1.40, 95 %CI 1.25–1.57, vs. HR+/HER2−). Median survival improved over time, but varied substantially across race/ethnicity (Asians: 34 months; African Americans: 6 months), neighborhood socioeconomic status (SES) (highest: 34 months, lowest: 20 months), and molecular subtype (HR+/HER2+: 45 months; triple negative: 12 months). In a multivariable model, triple negative (RH 2.85, 95 % CI 2.50–3.24) and HR−/HER2+ (RH 1.60, 95 % CI 1.37–1.87) had worse, while HR+/HER2+ had similar, risk of all-cause death compared to HR+/HER2− breast cancer.

Conclusions

De novo metastatic breast cancer was more likely to be HER2+. Among metastatic tumors, those that were HER2+ had better survival than other subtypes.

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Acknowledgments

The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract HHSN2612010000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #1U58 DP000807-01 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the authors and endorsement by the State of California, Department of Health Services, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors are not intended nor should be inferred.

Financial support

This project was funded by Genentech which develops products that target cancer entities described in this paper. The funding came to the Cancer Prevention Institute of California, and the terms of this arrangement were reviewed and approved by the Cancer Prevention Institute of California in accordance with its policy regarding objectivity in research.

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Authors and Affiliations

  1. Cancer Prevention Institute of California, Fremont, CA, USA

    Li Tao, Lisa Moy, Scarlett L. Gomez & Christina A. Clarke

  2. Genentech, Inc., San Francisco, CA, USA

    Laura Chu, Lisa I. Wang, Melissa Brammer, Chunyan Song & Marjorie Green

  3. Departments of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Allison W. Kurian, Scarlett L. Gomez & Christina A. Clarke

  4. Departments of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA

    Allison W. Kurian, Scarlett L. Gomez & Christina A. Clarke

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  1. Li Tao
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  2. Laura Chu
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  3. Lisa I. Wang
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  8. Allison W. Kurian
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Correspondence to Li Tao.

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Tao, L., Chu, L., Wang, L.I. et al. Occurrence and outcome of de novo metastatic breast cancer by subtype in a large, diverse population. Cancer Causes Control 27, 1127–1138 (2016). https://doi.org/10.1007/s10552-016-0791-9

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  • DOI: https://doi.org/10.1007/s10552-016-0791-9

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