Causes of Death and Relative Survival of Older Women After a Breast Cancer Diagnosis
- 20 April 2011
- journal article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 29 (12), 1570-1577
- https://doi.org/10.1200/jco.2010.33.0472
Abstract
Purpose To understand the impact of breast cancer on older women's survival, we compared survival of older women diagnosed with breast cancer with matched controls. Methods Using the linked 1992 to 2003 Surveillance, Epidemiology, and End Results (SEER) -Medicare data set, we identified women age 67 years or older who were newly diagnosed with ductal carcinoma in situ (DCIS) or breast cancer. We identified women not diagnosed with breast cancer from the 5% random sample of Medicare beneficiaries residing in SEER areas. We matched patient cases to controls by birth year and registry (99% or 66,039 patient cases matched successfully). We assigned the start of follow-up for controls as the patient cases' date of diagnosis. Mortality data were available through 2006. We compared survival of women with breast cancer by stage with survival of controls using multivariable proportional hazards models adjusting for age at diagnosis, comorbidity, prior mammography use, and sociodemographics. We repeated these analyses stratifying by age. Results Median follow-up time was 7.7 years. Differences between patient cases and controls in sociodemographics and comorbidities were small (< 4%). Women diagnosed with DCIS (adjusted hazard ratio [aHR], 0.7; 95% CI, 0.7 to 0.7) or stage I disease (aHR, 0.8; 95% CI, 0.8 to 0.8) had slightly lower mortality than controls. Women diagnosed with stage II disease or higher had greater mortality than controls (stage II disease: aHR, 1.2; 95% CI, 1.2 to 1.2). The association of a breast cancer diagnosis with mortality declined with age among women with advanced disease. Conclusion Compared with matched controls, a diagnosis of DCIS or stage I breast cancer in older women is associated with better survival, whereas a diagnosis of stage II or higher breast cancer is associated with worse survival.Keywords
This publication has 22 references indexed in Scilit:
- Improved Estimates of Cancer-Specific Survival Rates From Population-Based DataJNCI Journal of the National Cancer Institute, 2010
- Breast Cancer Among the Oldest Old: Tumor Characteristics, Treatment Choices, and SurvivalJournal of Clinical Oncology, 2010
- Changes in the risk of death from cancer up to five years after diagnosis in elderly patients: A study of five common cancersInternational Journal of Cancer, 2009
- Estimating breast cancer-specific and other-cause mortality in clinical trial and population-based cancer registry cohortsCancer, 2009
- Mammography Screening Among Women Age 80 Years and Older: Consider the RisksJournal of Clinical Oncology, 2009
- Mammography Before Diagnosis Among Women Age 80 Years and Older With Breast CancerJournal of Clinical Oncology, 2008
- Differences in Management of Older Women Influence Breast Cancer Survival: Results from a Population-Based Database in SwedenPLoS Medicine, 2006
- Variation in survival after diagnosis of breast cancer in SwitzerlandAnnals of Oncology, 2005
- The effect of changes in tumor size on breast carcinoma survival in the U.S.: 1975–1999Cancer, 2005
- Patient Demographic and Socioeconomic Characteristics in the SEER-Medicare DatabaseMedical Care, 2002