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Original Investigation
March 16, 2017

Brain Metastases in Newly Diagnosed Breast CancerA Population-Based Study

Author Affiliations
  • 1Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
  • 2Department of Biostatistics, Harvard T. H. Chan School of Public Health, and Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 3Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
  • 4School of Public Health, Yale University, New Haven, Connecticut
  • 5Department of Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
  • 6Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
JAMA Oncol. Published online March 16, 2017. doi:10.1001/jamaoncol.2017.0001
Key Points

Question  What are the incidence and prognosis of patients with breast cancer and brain metastases at diagnosis?

Findings  In this population-based cohort study, patients with triple-negative and hormone receptor–negative human epidermal growth factor receptor 2–positive subtypes and metastatic disease to any distant site harbored the highest likelihood (11.37% and 11.45%, respectively) of presenting with brain metastases at diagnosis of breast cancer. The prognosis of patients with triple-negative disease was poorest (median survival, 6 months).

Meaning  Future studies evaluating the utility of screening brain magnetic resonance imaging among patients at high risk of brain metastases may be warranted.

Abstract

Importance  Population-based estimates of the incidence and prognosis of brain metastases at diagnosis of breast cancer are lacking.

Objective  To characterize the incidence proportions and median survivals of patients with breast cancer and brain metastases at the time of cancer diagnosis.

Design, Setting, and Participants  Patients with breast cancer and brain metastases at the time of diagnosis were identified using the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. Data were stratified by subtype, age, sex, and race. Multivariable logistic and Cox regression were performed to identify predictors of the presence of brain metastases at diagnosis and factors associated with all-cause mortality, respectively. For incidence, we identified a population-based sample of 238 726 adult patients diagnosed as having invasive breast cancer between 2010 and 2013 for whom the presence or absence of brain metastases at diagnosis was known. Patients diagnosed at autopsy or with an unknown follow-up were excluded from the survival analysis, leaving 231 684 patients in this cohort.

Main Outcomes and Measures  Incidence proportion and median survival of patients with brain metastases and newly diagnosed breast cancer.

Results  We identified 968 patients with brain metastases at the time of diagnosis of breast cancer, representing 0.41% of the entire cohort and 7.56% of the subset with metastatic disease to any site. A total of 57 were 18 to 40 years old, 423 were 41 to 60 years old, 425 were 61-80 years old, and 63 were older than 80 years. Ten were male and 958 were female. Incidence proportions were highest among patients with hormone receptor (HR)-negative human epidermal growth factor receptor 2 (HER2)-positive (1.1% among entire cohort, 11.5% among patients with metastatic disease to any distant site) and triple-negative (0.7% among entire cohort, 11.4% among patients with metastatic disease to any distant site) subtypes. Median survival among the entire cohort with brain metastases was 10.0 months. Patients with HR-positive HER2-positive subtype displayed the longest median survival (21.0 months); patients with triple-negative subtype had the shortest median survival (6.0 months).

Conclusions and Relevance  The findings of this study provides population-based estimates of the incidence and prognosis for patients with brain metastases at time of diagnosis of breast cancer. The findings lend support to consideration of screening imaging of the brain for patients with HER2-positive or triple-negative subtypes and extracranial metastases.

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