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Annals of Oncology Advance Access published online on June 7, 2009
Annals of Oncology, doi:10.1093/annonc/mdp301
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Treatment and survival in breast cancer in the Eastern Region of England

G. C. Wishart1, D. C. Greenberg2, P. Chou3, C. H. Brown2, S. Duffy3 and A. D. Purushotham4,*

1 Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge
2 Eastern Cancer Registration and Information Centre Unit C, Cambridge
3 Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, London
4 King's College London and Guy's and St Thomas’ National Health Service Foundation Trust, Guy's Hospital, London, UK

* Correspondence to: Prof. A. D. Purushotham, Section of Research Oncology, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. Tel: +44-207-188-3027; Fax: +44-207-188-0919; E-mail: amy.byrtus{at}kcl.ac.uk

Background: The reasons for variation in survival in breast cancer are multifactorial.

Methods: From 1999 to 2003, the vital status of 9051 cases of invasive breast cancer was identified in the Eastern Region of England. Survival analysis was by Cox proportional hazards regression. Data were analysed separately for patients aged <70 years and those older due to differences in treatment policies.

Results: Overall 5-year survival was 78%. In patients aged <70 years, significant differences in survival lost their formal significance after adjustment for detection mode and node status, although this remained close to statistical significance with some residual differences between relative hazards. There was significant negative ecological correlation between proportion with nodes positive or not examined and 9-year survival rates. Patients with estrogen receptor (ER) status unknown were at significantly higher risk of dying than ER-positive patients. There was a clear trend of increasing hazard of dying with increasing deprivation. Survival differences in women aged ≥70 years were related to whether surgery was included as part of treatment.

Conclusion: This variation in treatment and survival may be attributed to lack of information, in particular nodal and ER status, thereby impacting on staging and prescription of adjuvant therapy.

breast cancer, survival, treatment, variation

Received for publication April 5, 2009. Revision received April 23, 2009. Accepted for publication April 28, 2009.


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