Category Archives: breast cancer survival

ASCO 2015: No change in metastatic breast cancer survival found at one Canadian institution, 1970 – 2013

This in itself is bad news, but the investigators also noted some alarming trends in the aggressiveness of metastatic disease once it emerged in later years.

The purpose of this study, not formally presented at the 2015 ASCO Annual Meeting but published in conjunction with the meeting,  was to look at survival of metastatic breast cancer patients from 1970 through 2013 at a hospital in Montreal.  Using a tumor registry, investigators found 1079 patients who had developed metastatic disease, and divided them into 4 cohorts according to the diagnosis of the metastatic disease (cohort 1: 1970-1995 (339 patients), 2: 1996-2000 (292), 3: 2001-2005 (249) and 4: 2006 plus (199)).

The median age of diagnosis of metastatic disease increased over time, from 54 to 58 years of age, and the time until metastatic diagnosis was significantly delayed, from 4.2 years to 5.7 years after initial diagnosis.  However, overall survival did not change, from cohort 1 to cohort 4 (initial diagnosis until death). So while the appearance of metastatic disease was delayed, this did not result in increasing survival.

The investigators hypothesize that a parallel increase in the use of adjuvant hormonal therapy, such as tamoxifen, might explain the delay in the development of the metastatic disease, but that perhaps this therapy was also leading to a drug resistance, making the metastatic disease harder to control.  A disturbing trend was that the aggressiveness of the disease when it appeared increased between cohort 1 and 4: the percentage of patients with visceral disease (metastatic disease appearing in organs such as the lung and liver) when first diagnosed with metastases increased from 33% to 45% between cohort 1 and 4.

The investigators conclude ” In our institution, no increase in overall survival was noted between the initial diagnosis and death throughout cohorts 1 to 4, but the significant increase in time to progression from initial diagnosis may reflect that adjuvant therapy delays disease progression.”

It’s been awhile since I’ve posted a blog entry.  I’ve been learning a lot about the trends in research and treatment directed at many other tumor types beyond breast cancer, as part of my job as an oncology news editor.  Now I’m hoping to occasionally stop by to share information and insights I’m gathering along the way that might be helpful for breast cancer advocates. I’m particularly interested in sharing developments in immunotherapy, or therapy aimed at boosting an individual’s unique defense against cancer development and spread.  When these therapies work – so far only in a subset of patients, particularly those with melanoma, lung cancer, or bladder cancer – they often work for the long haul, not just for a month or two.  These developments are causing a buzz in the oncology world, and I think offer the most promise for making meaningful differences in women’s lives, changing these dismal numbers for those who develop metastatic disease.  Several studies are currently underway to look at these therapies in breast cancer.


Surgery May Increase Survival in Stage IV Breast Cancer

Study results presented today at a European Cancer Organization conference in Berlin  may give physicians a reason to rethink the standard of care for Stage IV or metastatic breast cancer.

Treatment for women who are diagnosed from the beginning with a Stage IV breast cancer, or one that has spread to other parts of the body, is  typically focused on systemic, or whole-body treatments, such as chemotherapy.  Surgery to remove the primary tumor is usually not a priority in the treatment of metastatic disease.

However, researchers in The Netherlands found significant differences in survival between those who had had surgery to remove the primary tumor versus those who had not. In a retrospective study of 728 patients, the researchers discovered that those patients who had received surgery survived an average of 31 months, compared to 14 months for those who did not receive surgery. The five-year survival rates were also significantly different – 24.5% for the surgery group, compared to 13.1% for the non-surgery group.  Having had surgery was an independent prognostic factor even after adjusting for age, period of diagnosis, the number of metastatic sites and different types of treatment.

The researchers suggest that removal of the primary tumor reduces the number of circulating tumor cells in the rest of the body, or perhaps reactivates the immune system.  They are doing further analysis to determine if those who received surgery presented with less severe symptoms and perhaps had less severe disease.  They also plan to expand the study to look at the records of 10,000 patients over the last ten years.  In addition, the researchers would like to work with the Dutch Breast Cancer Research Group to set up a national randomised controlled trial to prospectively study the effect of surgery in Stage IV breast cancer patients.

Lots more work needs to be done to address the needs of women with Stage IV metastatic disease.  But this is one, small, encouraging step forward.

Research results presented today in Berlin, by Dr. Jetske Ruiterkamp, a surgeon from the Jeroen Bosch Hospital, Den Bosch, The Netherlands, at a European cancer congress, ECCO-15 and ESMO-34.

Will More US Women Die of Breast Cancer with Healthcare Reform?

Three hundred thousand more women will die of breast cancer each year in the US if proposed health care reform takes place, according to a multi-million dollar television ad campaign running in several states this week.   The ads, sponsored by the Independent Women’s Forum, cite as evidence a report from Lancet Oncology that shows “England’s breast cancer survival rate is much lower than in the US.”

What’s the truth?  The truth is LESS women will die of breast cancer in the US if every woman has access to screening and treatment for breast cancer.  The American Cancer Society  looked at insurance status and cancer outcomes in 2005 and 2006.  Not surprisingly, only 38% of women between 40-64 years with no insurance had had a mammogram in the previous two years, compared to 75% of those with private insurance.  More importantly, patients with no insurance were more likely to be diagnosed with Stage III or Stage IV breast cancer, and less likely to be diagnosed with a Stage I cancer.

And survival from breast cancer?  The 5-year survival rate was 76% for all uninsured patients, and 65% for uninsured African American women, compared to 89% for White women with private insurance.  We may have some of the best breast cancer care available in the world, but unfortunately, it’s just not universally available to all US women.

Now back to the ad – what about this Lancet Oncology report they cite?  According to their website, they are referring to an article published in 2008, “Cancer Survival in five continents: a worldwide population-based study (CONCORD).”  The article gives 5-year survival rates for breast cancer – the US came in at 84%, compared to 70% for the UK.  What they left out in the ad were the 5-year survival rates in the article from several other countries that have universal health coverage: Sweden 82%, Canada 83%, Australia 81%, Japan 82% and Cuba 84%.

There has been a lot written about the differences between the datasets in England and the US, and differences in how the rates were obtained.  But the most important thing to know is that the UK rates are determined from a cancer registry that includes everyone.  The US rates are estimates, based on SEER data, which include about 10% of the population, and only those who access the healthcare system.

The other striking thing I noticed in digging around – England has made terrific strides in breast cancer care.  According to the latest registry figures, the 5-year survival rate for breast cancer is now just over 80% (the 70% figure was from early ’90s data).  Since 1989, breast cancer mortality has fallen by 36% in the UK.   They recognized a problem and took steps to correct it.  What strikes me, is how much more effective it must be to implement new public health initiatives in a country when you have consistent care and universal coverage.  To improve public health in our country, so much time and energy must be spent trying to reach those outside the heathcare system.   But that’s another day’s topic….

Every major breast cancer advocacy group in the US is calling for healthcare reform to improve breast cancer care in our country.  Shame on the IWF for using breast cancer to scare people away from healthcare reform.

*Thanks to my advocate friends, Liz here in the US, and Sara in the UK, for helping me find information for today’s blog.