Crossing the blood–brain barrier: Temporal trends and disparities in mortality from breast cancer with brain metastasis among postmenopausal women in the United States, 1999–2025.
Year: 2026
Type: conference-abstract
Abstract: 730 Background: Breast cancer remains the most common malignancy in women and a leading cause of cancer mortality. Brain metastases occur in about 10–16% of patients when circulating tumour cells spreads through the blood–brain barrier, leading to severe neurological decline, treatment resistance, and poor survival. As systemic therapies improve and survival extends, the brain increasingly acts as a sanctuary site for metastatic progression, potentially shifting long-term mortality patterns. In postmenopausal women, age-related and tumor biology differences may further affect outcomes However, national mortality trends related to breast cancer with brain metastasis in postmenopausal women remain poorly defined. Therefore, this study evaluates long-term trends and disparities in this population in the United States from 1999 to 2025. Methods: A retrospective cohort study was conducted using CDC WONDER database from 1999-2025. Breast cancer (ICD-10 C50.0-C50.9) was defined as the underlying cause with brain metastasis (C79.3) as a contributing cause in women ≥55 years. Age-adjusted mortality rates (AAMRs) were standardized to the 2000 U.S. population. Analyses were stratified by age, race, region, and urbanization. Joinpoint regression estimated annual percentage change (APC) and average annual percent change (AAPC) with 95% confidence intervals; p<0.05 was significant. Results: A total of 37,895 deaths were recorded. Mortality declined from 1999-2007 (APC: −3.63; 95% CI: −5.40 to −2.79), stabilized from 2007-2013 (APC: 0.49; 95% CI: −2.02 to 2.22), then rose sharply from 2013-2018 (APC: 4.59; 95% CI: 3.06 to 7.21), followed by a plateau from 2018-2025 (APC: 0.63; 95% CI: −0.38 to 1.32). The highest burden was observed in women aged 65-74 years, while those ≥85 years demonstrated a sustained increase over time (AAPC: 0.95; 95% CI: 0.02 to 1.91). Black women experienced higher mortality than White women in 2025 (AAMR: 4.49 vs 3.62). Hispanic women showed a sustained upward trend (AAPC: 1.89; 95% CI: 1.26 to 2.78). Regionally, the West rose markedly (AAPC: 1.63; 95% CI: 1.03 to 2.65), while the Northeast declined persistently (AAPC: −1.80; 95% CI: −2.28 to −1.31). Arkansas (5.40), Mississippi (4.88), and Iowa (4.75) had the highest state-level AAMRs, whereas Maine (1.88) and Massachusetts (2.02) had the lowest. Non-metropolitan regions consistently showed higher mortality than metropolitan areas. Conclusions: Mortality from breast cancer with brain metastasis in postmenopausal women showed an overall stable trajectory. Significant disparities persist across demographics and geographical regions. These findings highlight the need for targeted surveillance, equitable access to advanced oncologic care, and continued monitoring of population-level trends.
Source: JCO Oncology Practice
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7221663506