Five Year Conditional Relative Survival up to 10 Years Postdiagnosis among Adolescent and Young Adult Breast Cancer Patients by Age, Stage, and Receptor Subtype

Many cancer survivors experience financial discrimination years after their remission, which leaves them often uninsured or underinsured for many years, if not for life. This financial burden can severely hinder their ability to return to normal life and participate fully in society.[1-3] Especially for adolescent and young adult (AYA) cancer survivors, who are in a developmental and challenging life phase, achieving financial stability is of high importance.[4-7] Moreover, with the growing number of AYA cancer survivors, policies and laws that protect survivors from financial toxicity are highly needed to support their reintegration into society.[8] In order to develop effective policies, detailed long-term survival data of AYA cancer survivors are essential. However, such data remain scarce. The study by Anderson et al. is one of the few that examined conditional long-term survival in AYA cancer patients.[9] Given the continuous advancements in cancer treatment and the resulting improvements in survival rates, long-term survival should be examined more continuously.[10] Breast cancer is the most common type of cancer among female AYAs.[11] In this context, the recent study by Vrancken Peeters et al. provides valuable insights. The study evaluated the conditional long-term survival and excess mortality up to 10 years postdiagnosis among AYA breast cancer patients stratified by age at diagnosis, tumor stage, and receptor subtype.[12] Data of all females aged 18–39 years and diagnosed with invasive breast cancer between 2003 and 2021 (n = 13,075) were obtained from the Netherlands Cancer Registry. Conditional relative survival (CRS), the probability of survival given that an individual has already survived a certain period postdiagnosis, is a clinically relevant and pragmatic measure for long-term survival.[13] The 5-year CRS, which estimates the probability of surviving an additional 5 years after a specific time postdiagnosis, was calculated annually up to 10 years postdiagnosis using a hybrid analysis approach.[14] The results of the study are potentially impactful, demonstrating that the overall excess mortality among AYA breast cancer patients tends to be little (CRS: 90%–95%) from diagnosis and becomes minimal over time compared to the general population [CRS >95% after 7 years, Figure 1]. Additionally, the subgroup analyses revealed important variations: patients with stage I disease or triple-negative tumors reached minimal excess mortality as early as diagnosis or 4 years postdiagnosis, respectively. In contrast, patients with stage III/IV disease or HR+ HER2− tumors did not reach the threshold of minimal excess mortality at 10 years postdiagnosis. This highlights the fact that grouping all AYA breast cancer patients may not be representative for individual cases – e.g., receptor subtype and tumor stage are extremely important factors.Figure 1: Five-year conditional relative survival (CRS) of the total adolescent and young adult breast cancer study population. At 0 year, the CRS is equivalent to the relative survival. The red dotted line indicates 95% CRS or minimal excess mortality relative to the general population. The blue dotted line indicates 90% CRS or little excess mortality relative to the general population. The gray area indicates the 95% confidence intervalsThese results provide valuable insights for both clinical and policy contexts. They can improve expectation management and shared decision-making regarding follow-up care during consultations by providing healthcare providers and patients with detailed, clinically relevant, and up-to-date long-term survival outcomes. Additionally, the findings are highly informative for policymakers to regulate insurance companies as required, ultimately leading to a more equitable insurance system.[15] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Data availability statement Further details of data referred to and discussed in the manuscript are available from the corresponding author upon request.