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Epidemiology of Early vs Late Recurrence Among Women With Early-Stage ER+ Breast Cancer
TAKE-HOME MESSAGE
- This retrospective analysis of data from 2992 women with stage I to II ER+ breast cancer included 341 patients (11.4%) who experienced recurrences. Of note, 53.7% of these patients had a late recurrence, defined as a recurrence occurring at or after 5 years since diagnosis. Higher disease stage and grade increased the risk of recurrence, regardless of whether it was an early or late recurrence. Endocrine therapy reduced the risk of recurrence; however, the length of endocrine therapy did not have a statistically significant effect on recurrence. Asian, Black, and Hispanic women, as well as patients with PR negativity, had a higher risk of early but not late recurrence.
- Approximately half of the recurrences were late recurrences. Ethnic-racial minority groups, as well as patients with PR− breast cancer, were more likely to have an early recurrence.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Relatively little is known about the differences in prognostic factors for early vs late recurrence among women with early-stage estrogen receptor-positive (ER+) breast cancer.
METHODS
We analyzed factors related to early (<5 years) vs late (≥5 years) recurrence in 2,992 women with stage I-IIB ER+ breast cancer in the Pathways Study, a prospective cohort of women with breast cancer enrolled between 2006 and 2013, with ascertainment of recurrence and death through December 2021.
RESULTS
After a median follow-up of 13.3 years, 341 (13.8%) women had recurrences, including 181 (53.7%) with late recurrence. Higher stage and grade were associated with recurrence regardless of timing, whereas progesterone receptor (PR) negativity was associated with early but not late recurrence. Receipt of endocrine therapy was associated with reduced risk of overall recurrence, but the length of endocrine therapy was not significant in multivariable models. Minoritized racial and ethnic groups, including Asian, Black, and Hispanic women, had higher risk of early but not late recurrence, compared with non-Hispanic White women. The trend of higher risk of early recurrence among these groups remained after adjustment for clinical, demographic, and socioeconomic factors, but was statistically significant only in Asian women.
CONCLUSIONS
Our study revealed potentially important distinctions for early vs late recurrence, including the associations with PR-negativity and self-identified race and ethnicity. Possible higher risk of early recurrence among Asian, Black, and Hispanic women provides novel evidence for the existence of disparities in cancer outcomes, even within the breast cancer subtype indicative of generally good prognosis.
Additional Info
Disclosure statements are available on the authors' profiles:
Epidemiology of early vs. Late recurrence among women with Early-Stage estrogen Receptor-Positive breast cancer in the pathways study
J. Natl. Cancer Inst 2024 Jun 06;[EPub Ahead of Print], AV Chua, H Sheng, E Liang, S Gandhi, ML Kwan, IJ Ergas, JM Roh, CA Laurent, L Yan, T Khoury, CB Ambrosone, LH Kushi, S YaoFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This is valuable information and will be helpful on many levels, such as in conversations with individual patients about recurrence risk and promoting additional studies that would include an analysis of HER2 status. The degree of positivity is an important element to factor in this information, given that even a 5% positivity for the estrogen receptor is considered sufficient to be classified as "positive."
We also do not know if patients were religious in taking their hormonal therapy as prescribed. From prior studies conducted regarding treatment adherence, we know that patients may initially take their medications; however, owing to side effects and the realization that they will be taking these drugs for 5 or more years, they may personally decide to take the medication every other day or not at all. Additionally, patients do not necessarily discuss with their oncologist the side effects (such as sexual dysfunction) that are disrupting their quality of life and, potentially, that of their spouse/partner. It would be interesting to know how compliant the patients included in this study were.