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Age, Tumor Stage Affect Breast Cancer Death

Odds fall as women age, unless disease is advanced

TUESDAY, Aug. 31, 2004 (HealthDayNews) -- Researchers from the National Cancer Institute have released what they say is one of the first comprehensive reports on the fates of women with breast cancer.

Here are some of the most striking things they found: The probability of dying from breast cancer as opposed to another cause generally goes down with age, but increases with later stages of the disease; women diagnosed with advanced stages of breast cancer and women who are diagnosed with less advanced stages at a young age are more likely to die of that cancer than all other causes combined; and black women with breast cancer were more likely to die of breast cancer and of other causes than were white women with the same disease.

The study appears in the Sept. 1 issue of the Journal of the National Cancer Institute.

"The point of the paper was to quantify these things in a way that hadn't been done systematically before," said study author Catherine Schairer, an epidemiologist with the National Cancer Institute. "It provides prognostic information to women and doctors."

"It's a large statistical study that says if you're younger and get breast cancer, you have a higher chance of dying because, most likely, the breast cancer is a more aggressive type of cancer than in older people," added Dr. Jay Brooks, chief of hematology/oncology at the Ochsner Clinic Foundation in New Orleans. "It does add increasing evidence that age of diagnosis is a very important prognostic feature."

None of this is new information, however, added Dr. Julia Smith, an oncologist at New York University Cancer Institute.

To provide improved prognostic information, Schairer and her colleagues analyzed data from a surveillance program of more than 400,000 women (395,251 white and 35,259 black) diagnosed with breast cancer between 1973 and 2000.

Probabilities of death from breast cancer and from all other causes combined over a 28-year follow-up period were calculated. These probabilities were stratified according to how old the woman was at diagnosis, stage of disease, and race. For women diagnosed between 1990 and 2000, tumor size and estrogen receptor status were also included.

For both black and white women, the probability of dying from breast cancer varied according to each of these factors: stage of the tumor, size of the tumor, estrogen receptor status, and age at diagnosis. The likelihood of dying from breast cancer went down as the age at diagnosis went up. At the same time, the probability of dying from breast cancer increased the further along the disease was at diagnosis. Women with estrogen receptor-negative tumors were more likely to die from breast cancer than women with positive tumors.

The probability of dying from breast cancer when the disease was localized among white women over the age of 70 was 33 percent lower than for white women under the age of 50 and 46 percent lower for black women. When the disease had spread, the probability of dying was 14 percent lower for white patients in the older age bracket and 13 percent lower for older black women.

It's not clear why black women faced a higher overall probability of dying. "More likely the main issues are things like access to care, nutrition, lifestyle," Smith said. "Even if they find a tumor early, are they getting adequate treatment? Are they getting lesser treatment than the Caucasian population? To me, this is the most interesting fallout [from the study], and it's not particularly new."

The results were not unexpected but they are complete. ?This provides information that hasn't been available before," Schairer said. "In terms of finding something radically different, no, but it quantifies. It gives women information."

More information

For more on breast cancer, visit the American Cancer Society.

SOURCES: Catherine Schairer, Ph.D., epidemiologist, National Cancer Institute, Rockville, Md.; Jay Brooks, M.D., chief of hematology/oncology, Ochsner Clinic Foundation, Baton Rouge, La.; Julia Smith, M.D., Ph.D., oncologist, New York University Cancer Institute, and clinical assistant professor, medicine, New York University School of Medicine, New York City; Sept. 1, 2004, Journal of the National Cancer Institute
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