Stage at diagnosis is a key explanation of differences in breast cancer survival across Europe

Abstract

We used multiple regression models to assess the influence of disease stage at diagnosis on the 5-year relative survival of 4,478 patients diagnosed with breast cancer in 1990 -1992. The cases were representative samples from 17 population-based cancer registries in 6 European countries (Estonia, France, Italy, Netherlands, Spain and UK) that were combined into 9 regional groups based on similar survival. Five-year relative survival was 79% overall, varying from 98% for early, node-negative (T1N0M0) tumours; 87% for large, node-negative (T2-3N0M0) tumours; 76% for node-positive (T1-3N؉M0) tumours and 55% for locally advanced (T4NxM0) tumours to 18% for metastatic (M1) tumours and 69% for tumours of unspecified stage. There was considerable variation across Europe in relative survival within each disease stage, but this was least marked for early nodenegative tumours. Overall 5-year relative survival was highest in the French group of Bas-Rhin, Cô te d'Or, Hé rault and Isè re (86%), and lowest in Estonia (66%). These geographic groups were characterised by the highest and lowest percentages of women with early stage disease (T1N0M0: 39% and 9%, respectively). The French, Dutch and Italian groups had the highest percentage of operated cases. The number of axillary nodes examined, a factor influencing nodal status, was highest in Italy and Spain. After adjusting for TNM stage and the number of nodes examined, survival differences were greatly reduced, indicating that for these women, diagnosed with breast cancer in Europe during 1990 -1992, the survival differences were mainly due to differences in stage at diagnosis. However, in 3 regional groups, the relative risks of death remained high even after these adjustments, suggesting less than optimal treatment. Screening for breast cancer did not seem to affect the survival patterns once stage had been taken into account.

The influence of socio-economic and surveillance characteristics on breast cancer survival: a French population-based study

“…These results are in agreement with the 5-year relative survival rate of 81.3% published in the EUROCARE-3 study from French population-based registries diagnosed in 1990 -1994 (Sant et al, 2003a). As highlighted in our study, survival varied significantly by county (Sant et al, 2003b). This is probably due to differences in the distribution of stage at diagnosis (Sant et al, 2003b) or to differences in the nature of the county (more urban or more rural) (Mitchell et al, 2006).…”

“…As highlighted in our study, survival varied significantly by county (Sant et al, 2003b). This is probably due to differences in the distribution of stage at diagnosis (Sant et al, 2003b) or to differences in the nature of the county (more urban or more rural) (Mitchell et al, 2006). We suggest that surveillance practices (a gynaecology consultation or a mammography during the years before diagnosis) as well as the circumstances of the mammography (screening or not) resulting from differences in the screening programmes in the counties may have influenced the stage at diagnosis.…”

Prognostic value of morphology and hormone receptor status in breast cancer – a population-based study

“…Previous studies on the present data set analysed the effect of tumour stage on survival (Sant et al, 2003(Sant et al, , 2004. We used this detailed stage information -available in 92% of cases -to adjust for stage in the multivariable analysis of prognostic effects of morphology and receptor status.…”

“…We analysed data on a representative sample of 4478 breast cancer patients investigated in previous EUROCARE high-resolution studies on breast cancer (Sant, 2001;Sant et al, 2003). All had primary invasive breast cancer diagnosed in 1990 -1992 in the territories of 17 population-based cancer registries in six countries: Estonia (national registry); France (Bas-Rhin, Calvados, Côte d'Or, Doubs, Hérault, Isère, Somme, and Tarn); Italy (Firenze, Modena, Ragusa and Varese); Spain (Granada); the Netherlands (Eindhoven) and the UK (Mersey and Thames).…”

How potentially serious symptom changes are talked about and managed in COPD clinical review consultations: A micro-analysis

“…This appears to have a tangible influence on the point at which people decide to seek medical help. At a practical level, for example, some individuals who smoke have been reported to hold the belief that if they present with chest-related symptoms, health professionals will view them as being at fault (Sant et al, 2003). Interestingly, it has also been reported that even when people eventually do decide that they need to see a doctor, they may not couch their presenting complaints as being particularly significant, or directly indicative of anything serious.…”