Abstract P2-08-29: Recent demographic changes show significant impact on age distribution and clinical characteristics of women presenting with de novo stage IV breast cancer
Authors: Khorasanchi Adam , Baer Lea , Stopeck Alison , Kudelka Andrzej , Cohen Jules 
Published: March 2020

Abstract
Introduction: Breast cancer is the most common cancer in women. In 2013, 16% of US women presenting with de novo Stage IV breast cancer cases were under age 50. The purpose of our study was to analyze the demographics and clinical characteristics of patients with de novo Stage IV breast cancer at our large tertiary care institution in the view of dramatic changes in the racial and ethnic makeup of Suffolk County, Long Island over the last 10 years.
Methods: Our study is a retrospective chart review of 159 female patients who presented with de novo Stage IV breast cancer to our institution during the years 2007-2019. Patients with recurrent Stage IV breast cancer were excluded. Charts of patients were reviewed and the following data was recorded: age at diagnosis, race, insurance status, menopausal status, presenting symptoms, family history, setting in which breast cancer was diagnosed, tumor histology, and sites of metastasis. Data was further subdivided into younger (under age 50) and older age groups (over age 69). Characteristics were compared using these groups.
Results: Data analysis revealed median age at diagnosis of 61, with a range between 26 and 92. 25% percent of women were under age 50, 50% ages 50-69 and 25% percent were 70 years of age or older. Over the last decade, proportion of younger women with de novo Stage IV breast cancer did not change significantly while there was a 14% increase in women presenting between ages 50 to 69, and 86% in the older subgroup.
80% were Non-Hispanic White, 9% Hispanic, 7% African-American. Over this past decade, non-Hispanic whites increased by 27%, 175% increase in Hispanics, and 20% increase in African-Americans. Overall, women were well-insured with 90% in younger group and 100% in older group having coverage at time of presentation. 60% of younger group were first diagnosed by their primary care physician compared to 42% of older group. Only 17% of younger group were diagnosed incidentally compared to 40% of older group. A majority of women had a known mass prior to diagnosis, 72% in younger group and 75% older group. 35% of younger group presented with other symptoms such as bone pain, weight loss compared to 52% of older group.
27% of younger women initially presented with an unrelated condition compared to 47% of older group. Proportion of patients with family history of breast cancer were similar, 57% in younger group and 52% in older group.
Overall, 26% were premenopausal. 73% had invasive ductal cancer. Majority had hormone receptor positive tumors, 65% in younger group compared to 82% older group. Finally, 54% of patients presented with multiple metastatic sites, 30% in both younger and older groups.
Conclusion: Our study analyzed the demographics and clinical characteristics of patients with de novo Stage IV breast cancer at our large tertiary care institution over the last 10 years.
The proportion of women 50 or younger diagnosed with de novo Stage IV breast cancer was 25% percent compared to 16% nationwide. The proportion of women presenting at age 70 or older has significantly increased over the past decade. This may be due to improving women’s life expectancy in the US but changes in patterns of screening of older women needs to be evaluated as well.
Over this past decade there was a 175% increase in Hispanic women presenting with de novo Stage IV breast cancer. This is in the setting of changing demographics of Suffolk County, Long Island which has increased its Hispanic population by 2% over the past 4 years according to census data. This dramatic change in mostly insured patients highlights the need for improved awareness and community outreach in this population.
Citation Format: Adam Khorasanchi, Lea Baer, Alison Stopeck, Andrzej Kudelka, Jules Cohen. Recent demographic changes show significant impact on age distribution and clinical characteristics of women presenting with de novo stage IV breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-29.