Summary Survival was analyzed during a follow-up period of up to 20 years in 406 (97%) of all 420 males in whom breast cancer was diagnosed in Sweden in 1960Sweden in -1978. After correction for the expected mortality in the general population, cumulated survival rates (with 95% confidence limits) of 66 (58.7-72.5)% and 52 (42.0-62.1)% at 5 and 10 years respectively were found. These figures and the general pattern of relative survival rates were in close accordance with those noted in a concomitant series of female breast cancer. There was a trend toward slightly improved survival rates during the period of study and the median survival times were 3.9, 4.8 and 7.2 years for patients diagnosed in 1960-64, 1965-69 and 1970-74 respectively. Age at diagnosis was seemingly unrelated to the long-term relative survival. We conclude that, except for a slightly higher mean age at diagnosis in males, there is a striking similarity in the natural history of breast cancer between men and women after initial treatment, with an excess death rate which still persists at long-term observation.

There was no decrease in the sensitivity of screening mammography in women currently using HRT, but there was a marginal decrease in specificity varying with the HRT regimen and duration of treatment.

Risk factors for a poor early outcome of surgery for stable angina pectoris were evaluated in 2659 consecutive patients from a defined population. The total operative mortality (death within 30 days after surgery) was 2.6% and the frequency of myocardial injury (increase in S-ASAT to greater than 2.0 mu kat l-1 and in S-CKMB to greater than 1.5 mu kat l-1 within 48 h postoperatively or death in the operating room) 14%. Mortality was related to New York Heart Association (NYHA) classification (P less than 0.001), age (less than or greater than 70 years, P = 0.001), duration of symptoms (less than or greater than 8 years, P = 0.001), aortic cross-clamp (ACC) time (P less than 0.001), and cardiopulmonary bypass (CBP) time (P less than 0.001). A multivariate analysis showed that the combination of NYHA class, ACC time and age best predicted operative mortality. Myocardial injury was related to NYHA functional class (P less than 0.001), duration of symptoms (P less than 0.001), regrafting procedure (P less than 0.001), cardiac related dyspnoea (P = 0.015), ACC time (P = 0.001), CPB time (P = 0.001), relative volume of cardioplegic solution (P less than 0.001), and thromboendarterectomy procedure (P = 0.004). The set of variables that best predicted myocardial injury consisted of ACC time, relative volume cardioplegic solution, NYHA class, regrafting procedure and duration of symptoms. However, these risk factors indicated only moderately high risks, and high-risk patients could not be selected with sufficient accuracy.

The duration of the reduction of mortality after coronary artery bypass grafting (CABG) is an important issue and this study was undertaken to evaluate time in relation to excess mortality among CABG patients compared with the general population. Survival was analysed in 4661 patients who had undergone their first isolated CABG. Observed survival was related to that expected among subjects from the general Swedish population stratified by age, sex and 5-year calendar period, to calculate relative survival and estimate disease-specific survival. Relative survival (including all deaths) was 94.6% at 5 years, 82.5% at 10 years, and 59.9% at 15 years. A multivariate model based on relative survival rates adjusted for age, year of surgery, severity of coronary disease, left ventricular function, and smoking habits was used. Compared with the first year of follow-up, the relative hazard (a measure of the risk of death) was at a minimum 2 years after surgery, but was dramatically increased after about 8 years. Relative survival was worsened by smoking at the time of operation and by moderate or severe left ventricular dysfunction pre-operatively. The survival rate was higher among patients operated on after 1985 than among those operated on earlier.

Introduction: Inflammatory breast cancer (IBC) is a rare aggressive form of breast cancer. It is well known that the long-term survival and progression-free survival of IBC are worse than that of non-IBC. We report the long term outcomes of patients with IBC and non-IBC who had undergone high-dose chemotherapy (HDC) with autologous hematopoietic cell transplantation (AHCT).Methods: All 3387 patients with IBC or non-IBC who underwent HDC with AHCT between1990-2002 and registered with CIBMTR were included in this analysis. Transplant-related mortality (TRM), disease relapse/progression, progression-free survival (PFS) and overall survival (OS) were compared between the two cohorts. Multivariate Cox regression model was used to determine the independent impact of stage on outcomes.Results: 527 patients with IBC and 2,860 patients with non-IBC were included; the median age at transplantation (47 vs 46 years old) and median follow-up period in the 2 groups (167 vs 168 months) were similar. The most common conditioning regimen was cyclophosphamide and carboplatin based in both groups (54% in IBC and 50% in non-IBC). AHCT was well tolerated in both groups. TRM was similar in both groups (one year TRM was 2% for IBC and 3% for non-IBC, p=0.16). The most common cause of death was disease progression or relapse (81% in IBC and 75% in non-IBC). The median survival for both IBC and non-IBC was the same at 40 months. The PFS at 10 years was 27% (95% CI: 23-31%) for IBC and 24% (95% CI: 22-26%) for non-IBC (p=0.21), and the OS at 10 years was 31% (95% CI: 27-35%) for IBC and 28% (95% CI: 26-30%) for non-IBC (p=0.16). In univariate analysis, patients with stage III IBC and no active diseases at transplantation had lower PFS and OS than that in non-IBC. In multivariate analysis, controlling for age, disease status at AHCT, hormonal receptor status, time from diagnosis to AHCT, and performance status at AHCT, patients with stage III IBC had higher mortality (HR 1.16, 95% CI: 1-1.34, p= 0.0459), worse PFS (HR: 1.17, 95% CI: 1.01-1.36, p= 0.0339) and higher risk of disease relapse/progression (HR: 1.24, 95% CI: 1.06-1.45, p= 0.0082) as compared to stage III non-IBC. Amongst all patients a higher stage disease was associated with worse PFS, OS and disease relapse/progression.Conclusions: Long-term outcomes of stage III IBC patients who underwent AHCT were poorer than that in non-IBC patients confirming that the poor prognosis of IBC even in the setting of HDC with AHCT.