Distant Recurrence Risk Decreases Among Recently Diagnosed Women With Node-Negative, ER-Positive Early Breast Cancer

By Cameron Kelsall, /alert Contributor
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Women diagnosed with node-negative, estrogen receptor-positive early-stage breast cancer in recent years have a lower risk for distant recurrence at 20 years post-diagnosis than those reported at earlier intervals, according to the results of a database study from the Early Breast Cancer Trialists’ Collaborative Group.

However, the researchers cautioned that greater long-term follow-up is still needed to fully understand the risks associated with long-term recurrence risk.


Photo by © MedMeetingImages/Todd Buchanan 2019

These data, which were presented at the 2019 San Antonio Breast Cancer Symposium, build upon previously published findings that women with estrogen receptor-positive early breast cancer, who remain disease-free after 5 years of endocrine therapy, are still at risk for recurrence for up to 20 years after diagnosis. Recurrences were strongly linked to tumor and nodal status.

The researchers previously reported that, among women diagnosed between 1976 and 2011, the 20-year distant recurrence risk was 13% for patients with T1N0 disease, 20% for patients with T1N1-3 disease, and 34% for patients with T1N4-9 disease.

To determine whether the risk was lower among women diagnosed more recently, the researchers accessed data from 82,598 women treated in 108 breast cancer trials, who were alive and well 5 years after initiating endocrine therapy.

The reported data included 19,675 more subjects than the previous dataset, including 11,391 women diagnosed since 2005.

Using women diagnosed before 1995 as a reference, the researchers found that the hazard ratio (HR) for distant recurrence among women diagnosed between 1995 and 1999 was 0.83 (95% CI, 0.77-0.9) in years 5-9 posttreatment.

HRs decreased to 0.64 (95% CI, 0.59-0.7) among women diagnosed between 2004 and 2004, and to 0.58 (95% CI, 0.52-0.65) among women diagnosed between 2005 and 2012.

A 30% lower risk of distant recurrence was seen among women diagnosed since 2000 when compared with women diagnosed before 2000 (HR, 0.7; 95% CI, 0.66-0.75). 

However, the median follow-up after year 5 among women diagnosed since 2000 was lower than those diagnosed before 2000 (median, 2.7 years vs. 6.1 years).

“The recurrence risk in years 5-10 after diagnosis in women diagnosed after 2000 was 3% for T1N0 and 5% for T2N0, with few events recorded after year 10,” the researchers concluded. “If these recurrence rates continue at the same rate, 20-year risk of DR for women diagnosed after 2000 is projected to be 8% and 14% for T1N0 and T2N0 stages, respectively, compared with 13% and 19% for those diagnosed before 2000.”

 

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