Women with stage IV breast cancer are more likely to not only survive but survive for an increasingly longer period of time after diagnosis, particularly those women who undergo initial breast surgery. In addition, advances in systemic therapy provide better control of distant disease. These findings were reported online ahead of print in the journal JAMA Surgery.1

This retrospective cohort study aimed to evaluate the patterns of initial breast surgery in female patients with stage IV breast cancer in the United States, with a focus on women who survived at least 10 years.

Using data from the Surveillance, Epidemiology, and End Results (SEER) program, the researchers identified female patients with stage IV breast cancer diagnosed between 1988 and 2011 who did not receive radiation therapy as part of their first course of treatment (N=21 372).

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Patient and tumor characteristics by receipt of breast surgery at diagnosis were compared via Kaplan-Meier estimates of median survival and descriptive statistics; demographic and clinical factors associated with survival and prolonged survival (at least 10 years) were assessed with a Royston-Parmar survival model and logistic regression analysis.

Median survival was found to have increased from 20 months in 1988-1991 to 26 months in 2007-2011. Rate of surgery also declined.

However, undergoing surgery was associated with improved survival in multivariate analysis. Survival of at least 10 years among women with cancer diagnosed before 2002 was seen in 9.6% of those who underwent initial breast surgery, but only 2.9% of those who did not undergo initial breast surgery.

Factors associated with survival of at least 10 years, in multivariate analysis, include surgery, hormone receptor-positive disease, older age, larger tumor size, marital status of being separated at the time of diagnosis, and more recent year of diagnosis.


1. Thomas A, Khan SA, Chrischilles EA, Schroeder MC. Initial surgery and survival in stage IV breast cancer in the United States, 1988-2011 [published online ahead of print December 2, 2015]. JAMA Surgery. doi:10.1001/jamasurg.2015.4539.