for those wondering what the recurrence risk is of T1a or1bNOMO breast cancer is

[Lani]

An article from MDAnderson reviewing over 52000 bc patients over more than 10 years (unfortunately did not include her2 status) shows the risk of nonbc-related death at 10 years was 24% and that of bc-related death at 10 years was 4%.

Obviously her2 bc tend to be diagnosed when bigger and with more mets as they usually grow faster and metastasis more widely so although her2+ bc constitutes 20-25% of breast cancer it constitutes far far fewer % OF Those discovered when they are small and have not metastasized.

Here it is:

J Clin Oncol. 2007 Nov 1;25(31):4952-60.

Overall survival and cause-specific mortality of patients with stage T1a,bN0M0 breast carcinoma.
Hanrahan EO, Gonzalez-Angulo AM, Giordano SH, Rouzier R, Broglio KR, Hortobagyi GN, Valero V.
Departments of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Unit 10, Houston, TX 77030, USA. ehanraha@mdanderson.org
PURPOSE: With mammographic screening, the frequency of diagnosis of stage T1a,bN0M0 breast cancer has increased. Prognosis after locoregional therapy and benefit from adjuvant systemic therapy are poorly defined. We reviewed T1a,bN0M0 breast cancer cases registered in the Surveillance, Epidemiology, and End Results (SEER) Program to investigate the impact of prognostic factors on breast cancer-specific (BCSM) and non-breast cancer-related mortality. METHODS: We identified T1a,bN0M0 breast cancer cases registered in the SEER Program from 1988 to 2001, and used the Kaplan-Meier product limit method to describe overall survival (OS). We estimated the probabilities of death resulting from breast cancer and from other causes, and analyzed associations of patient and tumor characteristics with OS, BCSM, and non-breast cancer-related mortality using the log-rank test, Cox proportional hazards models, and a competing-risk model. We constructed nomograms to assist physicians in adjuvant therapy decision making. RESULTS: We identified 51,246 T1a,bN0M0 cases. Median follow-up was 64 months (range, 1 to 167 months). Median age at diagnosis was 65 years (range, 20 to 101 years). Ten-year probabilities of all-cause mortality and BCSM were 24% and 4%, respectively. Characteristics associated with increased probability of BCSM included age younger than 50 years at diagnosis, high tumor grade, estrogen receptor-negative status, progesterone receptor-negative status, and fewer than six nodes removed at axillary dissection. The constructed nomograms allow a comparison of predicted breast cancer-specific survival and non-breast cancer-specific survival in individual patients. CONCLUSION: Overall, the prognosis of patients with T1a,bN0M0 breast cancer is excellent. However, subgroups of patients who are at higher risk of BCSM and who should be considered for adjuvant systemic therapy can be identified.

PMID: 17971593 [PubMed - in process]

[penelope]

Lani, I do not post much but log on everyday. I am so thankful for your research.

Where can I read the entire article?

Do we know whether these people had chemo or not?

Bless you for all your hard work, Lani!

[Lani]

If you go to their website I would guess they want money to read it. Perhaps you could go to the library if their is a local medical school and ask a librarian to help you find it to xerox it.

It is in the Nov 1, 2007 issue hot off the press ;Volume 25(number 31):pgs. 4952-60.

In the best of all possible worlds, people like Bill Gates would use their money to pay all these publications royalties so that every person from Ethiopia to Timbuktu could look up all these articles online for free.

Off my soapbox for now.

[Lani]

breast cancer patients-

There are limitations to our study. Most importantly, information on ADST use is not available in the SEER database. The proportion of patients who received adjuvant chemotherapy or hormonal therapy is unknown, and the BCSS calculated from SEER data may somewhat overestimate the outcome that would be found in an entirely untreated population. Data on tumor recurrence is not provided in the SEER database. However, evidence suggests that the accuracy of cause-of-death coding for cancer patients on death certificates and in SEER is high.43-46 Although the range of follow-up is long, the median is only 64 months. Nevertheless, because of the large number of patients available from SEER and the fact that 76% of patients are still at risk at 10 years, we can estimate 10-year survival with a high degree of confidence. Hormone receptor status was not measured in a central laboratory, and is not standardized in the population. Information on some other prognostic factors, such as lymphovascular invasion and human epidermal growth factor 2 (HER-2) status, is unavailable. Our nomograms allow for calculation of the probability of BCSS based on individual characteristics, but they do not consider the extent of comorbidities in the calculation of probability of non-BCSS. The Adjuvant! Online program can be used in conjunction with our nomograms to incorporate comorbidities into the estimation of individual non-BCSS probability.

Our data are derived from a large, population-based cohort and have a number of practical or clinical implications. T1a,bN0M0 cases overall have an excellent prognosis, but the nomograms will help clinicians identify who may be at higher risk of BCSM and assist in ADST decision making. Because most of these patients die as a result of other causes, many of which are at least partly lifestyle related (eg, cardiovascular), a healthy lifestyle and the management of non–breast cancer–related health problems in these patients are important.

[Grace]

Lani, thanks for positing recent research. Much appreciated.

"Because most of these patients die as a result of other causes, many of which are at least partly lifestyle related (eg, cardiovascular), a healthy lifestyle and the management of non–breast cancer–related health problems in these patients are important."

I wonder what editor let that sentence through?

Penelope,

If you consult Adjuvant Online, you can calculate your own prognosis, with or without chemotherapy. It allows for age, ER status, and current health status. It does not include HER2 status, yet. My ten year prognosis (T1) for breast cancer mortality on Adjuvant Online is the same as that given in the above article, 4%. Many oncologists use Adjuvant Online to provide prognosis information to their patients.