Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis
Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis
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DOI：
10.1200/jco.2006.09.2106
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发表时间：
2007-05-01
影响因子：
45.3
通讯作者：
Rosenberg, Philip S.
中科院分区：
文献类型：
--
作者：
Jatoi, Ismail;Chen, Bingshu E.;Rosenberg, Philip S.
自1990年以来，美国的乳腺癌总死亡率下降了24%。这种下降归因于乳房x光检查和辅助全身治疗。然而，这些方式的效果可能取决于雌激素受体（ER）的表达和年龄。因此，我们根据急诊室状况和年龄检查了美国乳腺癌死亡率趋势。方法使用监测、流行病学和最终结果（SEER）项目（1990-2003），我们计算了基于发病率的死亡率（IBM）的趋势，乳腺癌诊断后死亡的年危险率，以及er阳性和er阴性肿瘤女性的相对危险率。采用Cox比例风险模型评估相对危险率，调整分期和分级，并按诊断年龄分层。结果在研究期间，雌激素受体阳性和雌激素受体阴性肿瘤患者的IBM和年度乳腺癌死亡危险率下降，尽管雌激素受体阳性肿瘤患者的下降幅度更大。在70岁以下的女性中，er阳性肿瘤患者的相对危险率下降了38%，而er阴性肿瘤患者的相对危险率下降了19%。在70岁及以上的女性中，er阳性肿瘤患者的相对危险率下降了14%，而er阴性肿瘤患者的相对危险率没有显著下降。结论在美国，雌激素受体阳性和雌激素受体阴性肿瘤患者的乳腺癌死亡率均有所下降，其中年轻女性和雌激素受体阳性肿瘤患者的死亡率下降幅度更大。尽管所有组的死亡率仍然高得令人无法接受，但应进一步强调改善70岁以上的乳腺癌患者和所有年龄的er阴性肿瘤患者的预后。
PurposeSince 1990, overall breast cancer mortality rates in the United States decreased 24%. This decline has been attributed to mammography screening and adjuvant systemic therapy. However, the efficacy of these modalities may depend on estrogen receptor ( ER) expression and age. We therefore examined breast cancer mortality trends in the United States according to ER status and age.MethodsUsing the Surveillance, Epidemiology, and End Results ( SEER) program (1990-2003), we calculated trends in incidence-based mortality (IBM), annual hazard rates for breast cancer deaths after diagnosis, and relative hazard rates for women with ER-positive and ER-negative tumors. Relative hazard rates were assessed with Cox proportional hazards models, adjusted for stage and grade, and stratified by age at diagnosis.ResultsDuring the study period, IBM and annual hazard rates for breast cancer deaths decreased among women with ER-positive and ER-negative tumors, although declines were greater for those with ER-positive tumors. Among women younger than 70 years, relative hazard rates declined 38% for those with ER-positive tumors versus 19% for those with ER-negative tumors. Among women 70 years or older, relative hazard rates declined 14% for those with ER-positive tumors versus no significant decline for those with ER-negative tumors.ConclusionIn the United States, breast cancer mortality rates have declined among women with ER-positive and ER-negative tumors, with greater declines among younger women and those with ER-positive tumors. Although mortality in all groups remains unacceptably high, additional emphasis should be placed on improving outcomes of breast cancer patients older than 70 years and those of all ages with ER-negative tumors.