Abstract
Abstract
Background: Breast cancer patients tend to have distinctive characteristics that change as the cancer progresses to stage IV, especially in race and socioeconomic status. A previous SEER-based study reported blacks were diagnosed with a more advanced stage and larger tumor size compared to white patients'. This is the largest study to determine multiple factors associated with patients presenting with stage IV breast cancer.
Methods: A population-based study was conducted using the National Cancer Database (2000-2011), which contains 70% of all cancer diagnoses in the United States from 1658 American College of Surgeons Accredited-Hospitals. The initial diagnosis of stage IV disease in women represented 3.56% (81,476) of the total patient population (2,294,058). The demographics of the stage IV patients were compared to the entire database (all stages) of breast cancer patients using the chi square test.
Results: There was an increased incidence of stage IV Breast Cancer in patients with the following characteristics: Black, no insurance, Medicaid, Medicare, less educated, lower household income, and higher comorbidity (Table-1). Stage IV cancer incidence was higher in black patients (17%) compared to all stages (10%). There were 5,137 more black patients with stage IV than expected. Stage IV patients are three 3x more likely to have no insurance and 2x as likely to have Medicaid when compared to all stages. Stage IV patients tend to have less education and were twice as likely to have 2+ comorbidities. There was no increased incidence of stage IV disease in either Hispanics or in different age groups, and only a slight difference in distance traveled (not shown in table).
Conclusion: The following characteristics are more common in patients with stage IV disease: low income, Black, no insurance, Medicaid, less education, and higher comorbidity. Patients who were White, had private insurance, higher education and income status, and lower comorbidity had less representation in stage IV disease. These factors influence the occurrence of a more advanced stage of the disease. Identifying or more promptly treating patients in high-risk populations may reduce their incidence of stage IV disease.
'Silber, et, Al. "Characteristics Associated With Differences in Survival Among Black and White Women With Breast Cancer." JAMA 310.4 (2013): 389. JAMA. Web. 26 Jan. 2014.
Table-1: Epidemiology of Stage IV Breast Cancer Patients (2000-2011)Stage (%)All Stages (%)Observed/ Expected # of Patients**Race/ Ethnicity*White748060,519/ 65,425Black171013,611/ 8,474Hispanic554,219/ 3,748Insurance*None624,792/ 1,792Medicaid1058,326/ 3,911Medicare393532,614/ 28,843Private405432,614/ 43,916Education* % Without HS Degree*(Lower value=more education)>31%161112,609/ 8,96223-30.9%171514,169/ 11,89518-22%161512,991/ 12,05812-17.9%232418,854/ 19,717<12%243019,168/ 24,606Household Income*(per year)<$28,0001289,330/ 6,274$28,000-32,999131110,422/ 8,718$33,000-38,999171614,188/ 13,199$39,000-48,999232318,585/ 18,658>$49,000313725,269/ 30,391Comorbidity*0646651,832/ 54,01911198,855 /7,0072+423,178 /1,548* p-value < .0001 **Observed # of patients / % of all stages in category x total # of stage IV patients (Expected)
Citation Format: Jessica Gries, Van Do TH, Peter Silberstein. Epidemiology of stage IV breast cancer patients: A review of the National Cancer Database 2000-2011 [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr PD2-5.