Breast cancer is the second leading cause of cancer deaths in women, after lung cancer, and is the most common cancer among women (except for nonmelanoma skin cancers). Approximately 215,990 women in the United States will be diagnosed with invasive breast cancer (stages I-IV) in 2004. (Although much less common, breast cancer also occurs in men, with an estimated 1450 cases to be diagnosed in 2004.) According to estimates, 40,110 women and 470 men will die from breast cancer in the United States in 2004.¹

Individual breast cancer risk in women will depend on known factors such as family history, genetics, age of menstruation and yet undefined factors. A women's chances of breast cancer increases with age. The estimated risk of new breast cancer is 1 in 14 for women aged 60-79 compared with 1 in 24 for women aged 40 to 59 and 1 in 228 for women aged 39 and younger. Consequently, an estimated 35% of women are older than 70 when diagnosed with invasive breast cancer. Almost 50% will be age 65 or older; however, incidence rates continue to increase for women after the age of 50.²

More than 83,000 women per year are estimated to develop metastatic or refractory disease. Of these patients approximately 12,740 will be newly diagnosed with metastatic disease at the time of first diagnosis. Most women, however, develop metastatic disease when their original cancer relapses, which is usually within 2 to 3 years of primary diagnosis. Whereas less than 10% of patients present with overt metastatic disease, nearly one third of those with node-negative and more than half of those with node-positive disease will experience recurrence despite adjuvant therapy.³

According to the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute⁴:

• White, Hawaiian, and African American women have the highest incidence of invasive breast cancer in the United States (approximately four times higher than that of the lowest group).
• Korean, American Indian, and Vietnamese women have the lowest incidence of invasive breast cancer in the United States.
• African American have the highest death rate from breast cancer and are more likely to be diagnosed with a later stage of breast cancer than white women.

Among women aged 30 to 54 years and 55 to 69 years, African American women have the highest death rate from breast cancer, followed by Hawaiian women, and white non-Hispanic women. However, in the 70-year-old age-group, the death rate from breast cancer for white women is higher than that for African American women.⁴

The 5-year relative survival for women diagnosed with breast cancer increases with age until age 75. The projected 5-year relative survival for women younger than 45 years of age is 83%. Women aged 65 to 74 years have an expected 5-year relative survival of 89%.²

Five-year survival rates also vary based on stage of disease at diagnosis. The rate is estimated at 96.8% for women with localized disease and at 78.4% for those with regional disease. The estimate falls to 22.5% for patients with metastatic disease.²

The survival rate of women with metastatic breast disease also depends on the site of metastasis and the disease-free interval (DFI).

If the site of metastatic disease is visceral involvement (ie, metastasis to the lung or liver), patients have a median survival (MS) rate of 13 months, with a range of 1 to 24 months. For patients with bone involvement only, the MS is 28 months, with a range of 18 to 97 months.

Regarding a patient's DFI, the longer a patient is free of disease before there is a recurrence, or metastasis, the longer her survival. A DFI of 36 months indicates a more indolent or inactive disease, whereas a recurrence within 12 months indicates a more virulent or aggressive disease, with a shorter survival period.³

1.	Jemal A, Tiwari RC, Murray T, et al. Cancer statistics, 2004. CA Cancer J Clin. 2004;54:8-29.
2.	Holmes CE, Muss HB. Diagnosis and treatment of breast cancer in the elderly. CA Cancer J Clin. 2003;53:227-244.
3.	Chapp LI, Chorn N, Johnson L. Metastatic breast cancer: new agents and approaches to treatment. Care Management: Official Journal of the Academy of Certified Case Managers. 2003. Available at http://www.jcaremanagement.com/html/feature_16.html. Accessed November 1, 2004.
4.	Breast cancer: statistics on incidence, survival, and screening. Available at http://www.imaginis.com/breasthealth/statistics.asp. Accessed November 1, 2004.