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distant metastases (HzR 1.39; 1.20, 1.62), and visceral dominant disease (HzR 1.22; 1.05, 1.43). After 1998, HER2-positive disease was associated with better DSS (HzR = 0.72, 95% CI 0.56, 0.93). Conclusions Factors associated with the widening survival gap and non-equivalence between dnMBC and rMBC and decreased rMBC incidence warrant further study.

Adjuvant treatment of T1N0 breast cancer (BC) has evolved in recent years with chemotherapy options dependent on tumor size and cellular characteristics. Our goal is to describe the difference in outcome between T1N0 triple negative (TriNeg) and estrogen/progesterone receptor positive/her2/neu-negative BC. From our institute's registry, we identified primary BC patients diagnosed from 1998 to 2005, estrogen/progesterone receptor negative (ER-/PR-)/her-2/neu negative (her2-) (TriNeg = 110) and ER+/PR+/her2- (HR+/her2- = 919). Clinical diagnosis and treatment variables were chart abstracted. Vital and disease status were updated annually. Pearson chi-squared tests were used for bivariate analysis. Hazard ratios were calculated using the Cox proportional hazards model. Average patient age was 59 years, range 23-93 years and average length of follow-up was 4.22 years. T-stage distribution for HR+/her2- patients was 9% T1a (>0.1, < or = 0.5 cm), 34% T1b (>0.5 cm, < or = 1 cm), 57% T1c (>1 cm, < or = 2 cm) and for TriNeg, 6% T1a, 21% T1b, and 73% T1c. Sixty-five per cent of T1b and 73% T1c TriNeg patients received chemotherapy versus 7% of T1b and 32% of T1c HR+/her2- patients with TriNeg patients more likely to receive doxorubicin/cyclophosphamide/paclitaxel combined therapy. Recurrence rates were the following, T1b: 8.7%, TriNeg (2/23) versus 0%, HR+/her2- (0/315) and T1c: 8.8%, TriNeg (7/80) versus 2.1%, HR+/her2- (11/523). Five year relapse-free survival was 98% in the HR+/her2- group and 89% in the TriNeg group (log rank test = 27.77, p < 0.001). The hazard ratio for recurrence in the TriNeg group was 6.57 (95% CI = 2.34, 18.49) adjusted for age, tumor size, and adjuvant chemotherapy. Triple negative T1N0 patients have greater recurrence risk in spite of more aggressive therapy by both number treated and adjuvant chemotherapy type even in a low-risk category. New treatment modalities specific for triple negative disease are urgently needed.

Increased mammography-detected breast cancer over time coincided with lower-stage disease detection resulting in reduced treatment and lower rates of recurrence, adding factors to consider when evaluating the benefits of mammography screening of women aged 40-49 years.

Background It is not known to what extent improvement over time in breast cancer survival is related to earlier detection by mammography or to more effective treatments. Methods At our comprehensive cancer care center we conducted a retrospective cohort study of women ages 50–69 years diagnosed with invasive stage I–III breast cancer and followed over three time periods: 1990–1994, 1995–1999 and 2000–2007. Data was chart abstracted on detection method, diagnosis, treatment, and follow up for vital status in our breast cancer registry (n=2998). Method of detection was categorized as patient or physician (Pt/PhysD) or mammography detected (MamD). Cox proportional hazards models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for five year disease specific survival (DSS) in relation to detection method and treatment factors, testing for differences in survival using the Kaplan-Meier method. Results 58% of cases were MamD and 42% were Pt/PhysD with 56% stage I, 31% stage II and 13% stage III. Average length of follow up was 10.71 years. Combined five year DSS was 89% 1990–94, 94% 1995–99, and 96% in 2000–2007 (p<.001). In an adjusted model, mammography detection (HR=0.43, 95% CI 0.27–0.70), hormone therapy (HR=0.47, 95% CI 0.30–0.75), and taxane-containing chemotherapy (HR=0.61, 95% CI 0.37–0.99) were significantly associated with a decreased risk of disease-specific mortality Conclusions Better breast cancer survival over time is related to mammography detection, hormonal therapy and taxane-containing chemotherapy treatment. Treatment improvements alone are not sufficient to explain the observed survival improvements over time.