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. 2005 Jul 6;97(13):966-75.
doi: 10.1093/jnci/dji172.

Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute

Kenneth W Hance  1 , William F Anderson, Susan S Devesa, Heather A Young, Paul H Levine
Affiliations

Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute

Kenneth W Hance et al. J Natl Cancer Inst. .

Abstract

Background: Inflammatory breast carcinoma (IBC) appears to be a clinicopathologic entity distinct from noninflammatory locally advanced breast cancer (LABC). We examined incidence and survival trends for IBC in Surveillance, Epidemiology, and End Results (SEER) Program data with a case definition designed to capture many of its unique clinical and pathologic characteristics.

Methods: We analyzed breast cancer cases diagnosed in the SEER 9 Registries (n = 180,224), between 1988 and 2000. Breast cancer cases were categorized using SEER's "Extent of Disease" codes in combination with International Classification of Diseases for Oncology morphology code 8530/3 and classified as IBC (n = 3648), LABC (n = 3636), and non-T4 breast cancer (n = 172,940). We compared changes in incidence rates over 3-year intervals by breast cancer subtype and race using SEER*Stat. Survival differences by breast cancer subtype and race were assessed using Kaplan-Meier curves and log-rank statistics. All statistical tests were two-sided.

Results: Between 1988 and 1990 and 1997 and 1999, IBC incidence rates (per 100,000 woman-years) increased from 2.0 to 2.5 (P < .001), whereas those for LABC declined (2.5 to 2.0, P = .0025), as did those for non-T4 breast cancer (108 to 101, P = .0084). IBC incidence rates were statistically significantly higher in black women (3.1) than in white women (2.2) during the study period (P < .001). Women diagnosed with IBC had statistically significantly poorer survival than women with either LABC or non-T4 breast cancer (log-rank test, P < .001). Median survival of women with IBC (2.9 years) was statistically significantly shorter than that of women with LABC (6.4 years; P < .0001) or non-T4 breast cancer (> 10 years, P < .0001). Black women with IBC or LABC had poorer survival than white women with IBC or LABC, respectively (log-rank test, P < .001).

Conclusions: Throughout the 1990s, IBC incidence rose, and survival improved modestly. Substantial racial differences were noted in age at diagnosis, age-specific incidence rates, and survival outcomes.

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Figures

Fig. 1
Fig. 1
Age density histograms showing the age distributions of patients with different breast cancer subtypes. A) Non-T4 breast cancer; B) non-inflammatory locally advanced breast cancer (LABC); and C) inflammatory breast cancer (IBC). Data are from the Surveillance, Epidemiology, and End Results (SEER) 9 Registries, 1988–2000.
Fig. 2
Fig. 2
Age density histograms showing the age distributions of IBC patients with different estrogen receptor (ER) status. A) ER-negative status. B) ER-positive status. The solid line represents the age distribution in black women and the dotted line represents the age distribution in white women. Data are from the Surveillance, Epidemiology, and End Results (SEER) 9 Registries, 1988–2000. K.S. = Kolmogorov–Smirnov.
Fig.3
Fig.3
Age-specific incidence rates of breast cancer per 100 000 woman-years. Breast cancer cases grouped: A) using the Surveillance, Epidemiology, and End Results (SEER) coding conventions for noninflammatory locally advanced breast cancer (LABC) and inflammatory breast cancer (IBC); B) by three malignant breast cancer subtypes; C) by IBC definition. Data are from SEER 9 Registries, 1988–2000.
Fig.4
Fig.4
Age-specific incidence rates of breast cancer per 100 000 woman-years stratified by estrogen receptor (ER) status and race. A) Non-T4 breast cancer. B) Noninflammatory locally advanced breast cancer (LABC). C) Inflammatory breast cancer (IBC). Data are from the Surveillance, Epidemiology, and End Results (SEER) 9 Registries, 1988–2000.
Fig. 5
Fig. 5
Kaplan–Meier curves showing relative breast cancer-specific survival curves. Median survival time (m.s.t.) is expressed in years for each group. A) Breast cancer subtype. B) Inflammatory breast cancer (IBC) definition. Data are from the Surveillance, Epidemiology, and End Results (SEER) 9 Registries, 1988–2000.
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