Department of Family Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada.
Centre for Population Health Data at Statistics Canada, Government of Canada, Ottawa, ON K1A 0T6, Canada.
Curr Oncol. 2024 Sep 17;31(9):5544-5556. doi: 10.3390/curroncol31090411.
To characterize the histologic and molecular subtype distribution of, and survival from, breast cancer (BC) among Canadian women overall, and by stage and age at diagnosis. Invasive BC cases from the Canadian Cancer Registry for women aged 15-99 years between 2012 and 2017 in Canada, excluding Quebec, were examined using pre-existing mortality linkages. Stage at diagnosis, molecular, and histologic subtypes, and 5-year net survival (NS) by age, subtype, and stage were determined. 107,271 women with BC were included. Luminal A was the most common subtype, present in increasing proportions as women aged, up to a maximum of 55% of cases in 70-74. Ductal and luminal A were most likely to be diagnosed at stage I, while HER2+ had the highest proportion of diagnosis at stage III; triple negative (TN) and unknown had the highest proportion of stage IV. For all stages combined, luminal A had a five-year NS of 98%, while TN was 74%. NS for stage I BC was 99-100% for all subtypes, excepting TN, which was 96%. Survival decreased with advancing stage, most markedly for TN, for which stage III was 47% and stage IV 7%. Survival by equivalent stage and subtype was comparable across age groups but declined in older age categories. The varying natural histories of BC subtypes and histologies can inform prognoses, health system economics, and screening practices. The NS of 96% or greater for stage I, regardless of subtype, highlights the importance of early detection for all subtypes of BC, especially in aggressive subtypes.
为了描述加拿大女性总体以及按诊断时的分期和年龄分布的乳腺癌（BC）的组织学和分子亚型分布情况，以及生存情况。利用现有的死亡率关联，对加拿大癌症登记处 2012 年至 2017 年间年龄在 15-99 岁的加拿大非魁北克省女性的浸润性 BC 病例进行了检查。确定了诊断时的分期、分子和组织学亚型，以及按年龄、亚型和分期的 5 年净生存率（NS）。共纳入 107271 例 BC 患者。Luminal A 是最常见的亚型，随着女性年龄的增长，其比例逐渐增加，在 70-74 岁的病例中最多可达 55%。导管和 Luminal A 最有可能在 I 期诊断，而 HER2+在 III 期诊断的比例最高；三阴性（TN）和未知亚型在 IV 期诊断的比例最高。所有分期合并，Luminal A 的 5 年 NS 为 98%，而 TN 为 74%。所有亚型中，除 TN 外，I 期 BC 的 5 年 NS 均为 99-100%，TN 为 96%。随着分期的进展，生存率逐渐下降，TN 最为明显，其中 III 期为 47%，IV 期为 7%。在等效分期和亚型中，各年龄段的生存情况相似，但在年龄较大的年龄段下降。BC 亚型和组织学的不同自然史可以为预后、卫生系统经济学和筛查实践提供信息。无论亚型如何，I 期的 NS 为 96%或更高，突出了早期检测对所有 BC 亚型的重要性，尤其是在侵袭性亚型中。
