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The incidence of brain metastases in breast cancer according to molecular subtype and stage: a 10-year single institution analysis

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Abstract

Background

Breast cancer (BC) is the second most common etiology of brain metastases (BrM). We aimed to examine the incidence of BrM among all BC patients presenting to a large tertiary cancer centre over one decade.

Methods

We included all BC patients presenting consecutively between 2009 and 2019 and cross referenced that cohort to a radiotherapy database, identifying patients treated for BrM at any time following their initial presentation. Cumulative incidences (CI) of BrM diagnoses were calculated using death as a competing risk and compared using the Fine-Gray method. Overall survival was estimated using the Kaplan Meier method.

Results

We identified 12,995 unique patients. The CI of BrM in patients who initially presented with Stage 0–4 disease was 2.1%, 3.7%, 9.4%, 10.6%, and 28.7%, respectively at 10 years. For 8,951 patients with available molecular subtype data, 6,470 (72%), 961 (11%), 1,023 (11%), and 497 (6%) had hormone-receptor (HR)-positive/ERBB2-, HR-negative/ERBB2-, HR-positive/ERBB2 + , and HR-negative/ERBB2 + disease, respectively; the CI of BrM in each was 7.6%, 25.3%, 24.1%, and 26.6%, at 10 years following BC diagnosis, respectively. Median overall survival (OS) following BC diagnosis and BrM diagnosis was 28 years 95% CI [25, 32] and 10 months 95% CI [9, 12], respectively.

Conclusions

From a large, registry-based study, we observed that patients with ERBB2 + and triple negative BC have the highest incidence of BrM. Our data supports prospective surveillance brain MRI studies. Given advancements in BrM treatment, clinicians should have a low threshold for brain imaging in BC patients with high risk subtypes.

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Data availability

Data available on request due to privacy/ethical considerations.

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Funding

The authors have not disclosed any funding.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Christopher Poletes, Bardia Amanirad, Michael Yan, Tatiana Conrad & David B. Shultz

  2. Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Christopher Poletes, Bardia Amanirad, Michael Yan, Tatiana Conrad & David B. Shultz

  3. Royal College of Surgeons in Ireland, Dublin, Ireland

    Christopher Poletes

  4. Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada

    Anna T. Santiago

  5. Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada

    Katarzyna J. Jerzak

  6. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Katarzyna J. Jerzak

  7. Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada

    Katarzyna J. Jerzak

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  1. Christopher Poletes
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Contributions

C.P. Conceptualization-Equal, Data curation-Equal, Methodology-Equal, Project administration-Equal, Software-Equal, Supervision-Equal, Writing – original draft-Equal, Writing – review & editing-Equal B.A. Data curation-Equal, Software-Equal A.S. Formal analysis-Equal, Methodology-Equal, Validation-Equal, Validation-Equal M.Y. Conceptualization-Equal, Writing – review & editing-Equal T.C. Conceptualization-Equal, Writing – review & editing-Equal K.J. Writing – review & editing-Equal D.S. Conceptualization-Equal, Data curation-Equal, Investigation-Equal, Methodology-Equal, Project administration-Equal, Resources-Equal, Supervision-Equal, Writing – original draft-Equal, Writing – review & editing-Equal.

Corresponding author

Correspondence to Christopher Poletes.

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Ethics

All study procedures are performed in accordance with protocols approved by the research ethics board at the University Health Network. A exemption was granted by the ethics committee regarding written informed consent due to the anonymized retrospective nature of the data.

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The authors declare no competing interests.

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Précis: From a large, registry-based study, we observed that patients with ERBB2 + and triple negative BC have the highest incidence of BrM. Clinicians should have a low threshold to image the brain of patients with a history of BC who experience symptoms suggestive of BrM, especially in ERBB2 + and triple negative BC.

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Poletes, C., Amanirad, B., Santiago, A.T. et al. The incidence of brain metastases in breast cancer according to molecular subtype and stage: a 10-year single institution analysis. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04707-1

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