Jatoi Ismail, Chen Bingshu E, Anderson William F, Rosenberg Philip S
Department of Surgery, National Naval Medical Center and Uniformed Services, University of the Health Sciences, Bethesda, MD 20814, USA.
J Clin Oncol. 2007 May 1;25(13):1683-90. doi: 10.1200/JCO.2006.09.2106. Epub 2007 Apr 2.
Since 1990, overall breast cancer mortality rates in the United States decreased 24%. This decline has been attributed to mammography screening and adjuvant systemic therapy. However, the efficacy of these modalities may depend on estrogen receptor (ER) expression and age. We therefore examined breast cancer mortality trends in the United States according to ER status and age.
Using the Surveillance, Epidemiology, and End Results (SEER) program (1990-2003), we calculated trends in incidence-based mortality (IBM), annual hazard rates for breast cancer deaths after diagnosis, and relative hazard rates for women with ER-positive and ER-negative tumors. Relative hazard rates were assessed with Cox proportional hazards models, adjusted for stage and grade, and stratified by age at diagnosis.
During the study period, IBM and annual hazard rates for breast cancer deaths decreased among women with ER-positive and ER-negative tumors, although declines were greater for those with ER-positive tumors. Among women younger than 70 years, relative hazard rates declined 38% for those with ER-positive tumors versus 19% for those with ER-negative tumors. Among women 70 years or older, relative hazard rates declined 14% for those with ER-positive tumors versus no significant decline for those with ER-negative tumors.
In the United States, breast cancer mortality rates have declined among women with ER-positive and ER-negative tumors, with greater declines among younger women and those with ER-positive tumors. Although mortality in all groups remains unacceptably high, additional emphasis should be placed on improving outcomes of breast cancer patients older than 70 years and those of all ages with ER-negative tumors.
自1990年以来，美国乳腺癌总体死亡率下降了24%。这一下降归因于乳腺钼靶筛查和辅助性全身治疗。然而，这些治疗方式的疗效可能取决于雌激素受体（ER）表达和年龄。因此，我们根据ER状态和年龄研究了美国乳腺癌死亡率趋势。
利用监测、流行病学和最终结果（SEER）计划（1990 - 2003年），我们计算了基于发病率的死亡率（IBM）、诊断后乳腺癌死亡的年度风险率以及ER阳性和ER阴性肿瘤女性的相对风险率。相对风险率通过Cox比例风险模型进行评估，调整了分期和分级，并按诊断时的年龄进行分层。
在研究期间，ER阳性和ER阴性肿瘤女性的IBM和乳腺癌死亡年度风险率均有所下降，不过ER阳性肿瘤女性的下降幅度更大。在70岁以下女性中，ER阳性肿瘤女性的相对风险率下降了38%，而ER阴性肿瘤女性为19%。在70岁及以上女性中，ER阳性肿瘤女性的相对风险率下降了14%，而ER阴性肿瘤女性则无显著下降。
在美国，ER阳性和ER阴性肿瘤女性的乳腺癌死亡率均有所下降，年轻女性和ER阳性肿瘤女性下降幅度更大。尽管所有组的死亡率仍然高得令人无法接受，但应更加重视改善70岁以上乳腺癌患者以及所有年龄段ER阴性肿瘤患者的治疗结果。
