Advances in screening for disease detection, better surgical techniques available to more women, and an increased number of therapies that reduce the risk of relapse in patients with both locally advanced and early stage disease, have collectively contributed to dramatic improvements in breast cancer's survival rates, according to a review of 60 years of patient records at The University of Texas MD Anderson Cancer Center.
The single institution study found increases in both five and 10-year survival at every stage of the disease in every decade studied. Aman Buzdar, M.D., professor in MD Anderson's Department of Breast Medical Oncology presented the data in advance of the 2010 Breast Cancer Symposium.
Similar to that of the National Cancer Institute's (NCI) Surveillance, Epidemiology and End Results Program (SEER), MD Anderson's Department of Breast Medical Oncology has maintained a comprehensive database collecting information on incidence, prevalence and mortality since the institution's inception almost 70 years ago. MD Anderson is in a unique position in that it has the largest group in the country, perhaps in the world, committed to the treatment of breast cancer, explains Buzdar.
"The concept of combined, multi-disciplinary approach for the management of breast cancer care, and that of other cancers, was introduced early on and remains the cornerstone of our care," says Buzdar, the study's senior author. "At MD Anderson, new therapeutic advances have long-been incorporated into the clinical care of patients early-on, resulting in improved survival of patients within each stage of disease. Over the years, with the discovery of research milestones, we have published studies looking at MD Anderson patients to determine how these discoveries have impacted their survival."
For this retrospective, single-institution study, Buzdar and his team reviewed records of 56,864 breast cancer patients seen at MD Anderson between 1944 and 2004. Of those, 12,809 women had their initial therapy at the institution. For each decade, patients were determined to have one of three stages of disease: local, regional and distant, or metastatic.
Across the decades, the researchers looked at five and 10-year survival by stage, both of which were calculated from the date of initial presentation. From decade to decade, the researchers found an impressive increase in survival in all three stages of the disease, as well as overall survival:
|Years||Percent survival at 10 years (number of patients)|
|Local Disease||Regional Disease||Distant Disease||Overall*|
|1944-54||55.0% (120)||16.2% (191)||3.3% (92)||25.1% (410)|
|1955-64||56.0% (462)||23.9% (656)||4.0% (306)||30.5% (1,449)|
|1965-74||59.3% (440)||28.8% (566)||4.7% (321)||34.6% (1,387)|
|1975-84||72.0% (701)||46.9% (828)||7.4% (367)||49.3% (1,983)|
|1985-94||78.5% (1,036)||57.4% (1,268)||11.2% (364)||61.6% (2,927)|
|1995-04||86.1% (1,898)||74.1% (1,569)||22.2% (455)||76.5% (4,653)|
*Also includes patients with in situ or unknown stages of the disease
Buzdar notes the improved survival in metastatic patients of great significance as these patients have disease that may not be curable, yet a significant proportion of these patients can now live for a number of years with available therapies.
"In the first decade we tracked, 1944-1954, the 10-year survival of women with metastatic breast cancer was just 3.3 percent. However, between the decades of 1985-1994 and 1995-2004, the survival gain in the same cohort increased from 11.2 to 22.2 percent, respectively. This dramatic shift is a true testament to not only breast cancer's overall research and clinical milestones - improved chemotherapies, addition of new drugs, improvement of endocrine therapies and more recently biologics - but to the appropriate and disciplined approach and utilization of these therapies," says Buzdar.
A number of MD Anderson's research milestones have impacted clinical care and breast cancer survival, both at the institution, and beyond, says Buzdar, including: combined modality approach to the treatment of the disease; utilization of systemic therapies prior to surgery; refinement of chemotherapies, specifically the incorporation of anthracyclines, taxanes and biologics, and newer hormonal agents like aromatase inhibitors.
While these research milestones and study findings are obviously encouraging, still more needs to be done, he says.
"Now, we need to turn our attention to the refinement of breast cancer therapies, with a goal of further decreasing risk of recurrence and death for our high-risk early stage breast cancer patients, and maintaining the control of disease in those with metastatic disease," says Buzdar.
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