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Risk of Mortality by Histologic Type of Breast Cancer Among Women Aged 50 to 79 Years

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Risk of Mortality by Histologic Type of Breast Cancer Among Women Aged 50 to 79 Years ORIGINAL INVESTIGATION Risk of Mortality by Histologic Type of Breast Cancer Among Women Aged 50 to 79 Years Christopher I. Li, MD, PhD; Roger E. Moe, MD; Janet R. Daling, PhD Background: Recent studies suggest that the use of com- Results: Women with ILC had a risk of mortality 11% bined estrogen and progestin hormone replacement lower than women with IDC. The magnitude of this dif- therapy is associated with an increased risk of invasive ference has increased over the past 10 years and, from lobular carcinoma (ILC), but that it has little associa- 1994 through 1998, the risk of mortality was 26% lower tion with risk of invasive ductal carcinoma (IDC). Also, for women with ILC. Also, the risk of mortality was the incidence rates of ILC have risen over the past 10 years between 8% and 34% lower in women with mucinous while those of IDC have remained constant. Differences carcinoma, comedocarcinoma, or medullary, tubular, in survival rates by histologic types of tumor have been and papillary carcinomas compared with women with reported, but few of the published studies were popula- IDC. tion based or had adequate power to address this issue. Conclusions: Differences in prognosis by histologic type Methods: We conducted a retrospective cohort study of breast cancer were identified. The survival rate of spanning the years 1974 through 1998 using data from women 50 to 79 years old who have ILC, the cancer whose the 9 cancer registries that have participated in the Sur- histologic type is the most closely linked with the use of veillance, Epidemiology, and End Results Program since combined estrogen and progestin hormone replace- 1974. The cohort consisted of 164958 women aged 50 ment therapy, is more favorable than that of women with to 79 years who had been diagnosed as having 1 of 7 his- IDC and appears to be improving over time. tologic types of invasive breast cancer. Risks of mortal- ity due to any cause were estimated using the Cox pro- portional hazards model. Arch Intern Med. 2003;163:2149-2153 GROWING number of stud- tect than IDC by mammographic or clini- ies have found that the cal examination.10 use of combined estrogen It is important to compare the prog- and progestin hormone noses associated with different histologic replacement therapy types of breast cancer if the conse- A(CHRT) is associated with a 2.0- to 3.9- quences of the changing incidence rates fold increase in the risk of developing in- of some breast cancers are to be under- vasive lobular carcinoma (ILC), the sec- stood. Differences in risks of mortality ac- ond most common histologic type of cording to histologic types have been iden- breast cancer, but that it has little impact tified; yet, results are conflicting and the on the risk of developing the most com- types considered “favorable” are subject mon histologic type, invasive ductal car- to debate.11 With respect to ILC, studies cinoma (IDC).1-5 Specifically, 4 of these show that its prognosis is better,12-14 the studies found no association between use same,15 or worse16,17 than that of IDC. of CHRT and ductal carcinoma,1-3,5 but 1 Other studies have evaluated less com- found that women who ever used CHRT mon histologic types, but the available evi- had a 43% increase in the risk of devel- dence suggests that mucinous,18-22 med- oping ductal carcinoma.4 Although it has ullary,23-25 and tubular17,26-28 histologic types From the Fred Hutchinson been reported that ILC represents only are associated with a risk of mortality Cancer Research Center, about 5% to 10% of all breast cancer greater or similar to that of IDC. How- Division of Public Health cases,6,7 incidence rates of ILC have risen ever, few of these studies were popula- Sciences, Seattle, Wash steadily in the United States from 1987 to tion based, and most were hampered by (Drs Li and Daling), and the 1995,8 and in 1999 ILC accounted for 16% relatively small numbers of cases of these Department of Surgery, School 9 of Medicine, University of of all invasive breast cancers. Alterna- rare histologic types of breast cancer. Washington, Seattle (Dr Moe). tively, IDC rates have remained essen- To further our knowledge of the mor- The authors have no relevant tially constant over the same time despite tality risks of breast cancer according to financial interest in this article. the fact that ILC is more difficult to de- histologic types, we conducted a popula- (REPRINTED) ARCH INTERN MED/ VOL 163, OCT 13, 2003 WWW.ARCHINTERNMED.COM 2149 ©2003 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/28/2021 Table 1. Demographic, Carcinoma, and Treatment Characteristics of 164 958 Women Diagnosed as Having Breast Cancer Between 1974 and 1998 Histologic Type, No./Row %/Column % Ductal Lobular Mucinous Comedocarcinoma Medullary Tubular Papillary Characteristic (n = 132 284) (n = 19 383) (n = 3923) (n = 3157) (n = 2902) (n = 2260) (n = 1049) Age, y 50-59 43 734/80.6/33.1 6153/11.3/31.7 747/1.4/19.0 1347/2.5/42.7 1305/2.4/45.0 757/1.4/33.5 209/0.4/19.9 60-69 48 615/80.6/36.8 7014/11.6/36.2 1367/2.3/34.8 1149/1.6/36.4 994/1.6/34.3 802/1.3/35.5 391/0.6/37.3 70-79 39 935/79.3/30.2 6216/12.3/32.1 1809/3.6/46.1 661/1.3/20.9 603/1.2/20.8 701/1.4/31.0 449/0.9/42.8 Mean (SD) 64.1 (8.3) 64.5 (8.4) 67.4 (8.0) 62.1 (8.0) 61.9 (8.1) 64.1 (8.5) 66.9 (8.0) Year of diagnosis (5-year groups) 1974-1978 17 836/83.2/13.5 1648/7.7/8.5 568/2.7/14.5 270/1.3/8.6 828/3.9/28.5 128/0.6/5.7 153/0.7/14.6 1979-1983 21 648/82.4/16.4 2507/9.5/12.9 544/2.1/13.9 481/1.8/15.2 703/2.7/24.2 227/0.9/10.0 167/0.6/15.9 1984-1988 28 754/82.3/21.7 3729/10.7/19.2 723/2.1/18.4 572/1.6/18.1 566/1.6/19.5 355/1.0/15.7 227/0.6/21.6 1989-1993 30 266/78.8/22.9 4730/12.3/24.4 971/2.5/24.8 1053/2.7/33.4 459/1.2/15.8 691/1.8/30.6 252/0.7/24.0 1994-1998 33 780/76.9/25.5 6769/15.4/34.9 1117/2.5/28.5 781/1.8/24.7 346/0.8/11.9 859/2.0/38.0 250/0.6/23.8 Follow-up time, y Ͻ1 14 107/79.9/10.7 2425/13.7/12.5 368/2.1/9.4 211/1.2/6.7 203/1.2/7.0 259/1.5/11.5 75/0.4/7.1 1-3 25 645/80.8/19.4 3895/12.3/20.1 673/2.1/17.2 504/1.6/16.0 450/1.4/15.5 425/1.3/18.8 153/0.5/14.6 3-5 20 967/79.9/15.8 3262/12.4/16.8 577/2.2/14.7 586/2.2/18.6 340/1.3/11.7 367/1.4/16.2 152/0.6/14.5 5-10 36 233/79.6/27.4 5425/11.9/28.0 1128/2.5/28.8 1041/2.3/33.0 649/1.4/22.4 700/1.5/31.0 318/0.7/30.3 Ͼ10 35 332/80.6/26.7 4376/10.0/22.6 1177/2.7/30.0 815/1.9/25.8 1260/2.9/43.4 509/1.2/22.5 351/0.8/33.5 Mean (SD) 7.0 (5.6) 6.4 (5.3) 7.6 (5.8) 7.3 (5.3) 9.5 (6.8) 6.7 (5.3) 8.2 (5.9) Registry Atlanta 9494/7.2/81.4 1342/6.9/11.5 248/6.3/2.1 213/6.7/1.8 146/5.0/1.3 126/5.6/1.1 88/8.4/0.8 Connecticut 23 729/17.9/82.7 2935/15.1/10.2 614/15.7/2.1 476/15.1/1.7 498/17.2/1.7 268/11.9/0.9 157/15.0/0.5 Detroit 22 162/16.8/78.4 3693/19.1/13.1 582/14.8/2.1 687/21.8/2.4 633/21.8/2.2 318/14.1/1.1 192/18.3/0.7 Hawaii 5552/4.2/83.9 511/2.6/7.7 181/4.6/2.7 124/3.9/1.9 114/3.9/1.7 86/3.8/1.3 52/5.0/0.8 Iowa 17 306/13.1/80.5 2313/11.9/10.8 574/14.6/2.7 424/13.4/2.0 487/16.8/2.3 273/12.1/1.3 124/11.8/0.6 New Mexico 6619/5.0/80.2 1057/5.5/12.8 204/5.2/2.5 76/2.4/0.9 111/3.8/1.3 118/5.2/1.4 63/6.0/0.8 San Francisco-Oakland 22 571/17.1/79.3 3718/19.2/13.1 676/17.2/2.4 562/17.8/2.0 399/13.7/1.4 405/17.9/1.4 147/14.0/0.5 Seattle 18 494/14.0/78.3 3015/15.6/12.8 640/16.3/2.7 409/13.0/1.7 336/11.6/1.4 562/24.9/2.4 159/15.2/0.7 Utah 6357/4.8/80.5 799/4.1/10.1 204/5.2/2.6 186/5.9/2.4 178/6.1/2.3 104/4.6/1.3 67/6.4/0.8 Race/ethnicity Non-Hispanic white 112 945/85.4/79.9 17 308/89.3/12.2 3298/84.1/2.3 2592/82.1/1.8 2323/80.0/1.6 2042/90.4/1.4 784/74.7/0.6 Black 8749/6.6/80.8 952/4.9/8.8 278/7.1/2.6 287/9.1/2.7 340/11.7/3.1 75/3.3/0.7 146/13.9/1.3 American Indian 256/0.2/79.0 31/0.2/9.6 10/0.3/3.1 11/0.3/3.4 12/0.4/3.7 1/0.0/0.3 3/0.3/0.9 Asian/Pacific Islander 5600/4.2/84.5 434/2.2/6.5 186/4.7/2.8 156/4.9/2.4 120/4.1/1.8 55/2.4/0.8 76/7.2/1.1 Hispanic white 3466/2.6/80.3 483/2.5/11.2 114/2.9/2.6 81/2.6/1.9 83/2.9/1.9 57/2.5/1.3 30/2.9/0.7 Other/unknown 1268/1.0/80.6 175/0.9/11.1 37/0.9/2.4 30/1.0/1.9 24/0.8/1.5 30/1.3/1.9 10/1.0/0.6 Stage Localized 77 086/78.0/59.4 11 426/11.6/59.9 3314/3.4/86.1 2344/2.4/75.1 1747/1.8/61.2 2014/2.0/90.4 851/0.9/82.5 Regional 45 813/83.3/35.3 6640/12.1/34.8 447/0.8/11.6 700/1.3/22.4 1030/1.9/36.1 202/0.4/9.1 154/0.3/14.9 Distant 6918/84.3/5.3 1009/12.3/5.3 88/1.1/2.3 77/0.9/2.5 78/1.0/2.7 13/0.2/0.6 26/0.3/2.5 Missing 2467 308 74 36 47 31 18 Surgical treatment Performed 428/85.3/0.3 49/9.8/0.3 12/2.4/0.3 5/1.0/0.2 2/0.4/0.1 2/0.4/0.1 4/0.8/0.4 Not performed 122 172/80.3/99.7 17 478/11.5/99.7 3621/2.4/99.7 3010/2.0/99.8 2793/1.8/99.9 2057/1.4/99.9 979/0.6/99.6 Missing 9684 1856 290 142 107 201 66 Radiation therapy None 87 170/79.7/66.9 13 183/12.1/68.9 2647/2.4/68.5 2262/2.1/72.5 2045/1.9/72.2 1268/1.2/56.8 790/0.7/76.4 Treated 43 067/81.1/33.1 5942/11.2/31.1 1215/2.3/31.5 859/1.6/27.5 789/1.5/27.8 965/1.8/43.2 244/0.5/23.6 Missing 2047 258 61 36 68 27 15 tion-based retrospective cohort study of women diag- participating in the National Cancer Institute’s SEER Program.
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