Breast carcinoma survival in Europe and the United States

A population-based study

Authors

  • Milena Sant M.D.,

    Corresponding author
    1. Epidemiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
    • Epidemiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian 1, I-20133 Milan, Italy
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    • Fax: 011-39-02-2668-1292

  • Claudia Allemani Sc.D.,

    1. Epidemiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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  • Franco Berrino M.D.,

    1. Epidemiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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  • Michel P. Coleman M.D.,

    1. Cancer and Public Health Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
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  • Tiiu Aareleid M.D.,

    1. Department of Epidemiology and Biostatistics, Institute of Experimental and Clinical Medicine, Tallinn, Estonia
    2. Estonian Cancer Registry, North Estonian Regional Hospital Foundation's Cancer Centre, Tallinn, Estonia
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  • Gilles Chaplain M.D.,

    1. Côte d'Or Breast and Gynaecologic Cancer Registry, Centre Universitaire d'Epidémiologie de population, Faculté de Médicine, Dijon, France
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  • Jan Willem Coebergh M.D.,

    1. Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, The Netherlands
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  • Marc Colonna Ph.D.,

    1. Isère Cancer Registry, Meylan, France
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  • Paolo Crosignani M.D.,

    1. Lombardy Cancer Registry, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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  • Arlette Danzon M.D.,

    1. Doubs Cancer Registry, Centre Hospitalo-Universitaire, Besanç, France
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  • Massimo Federico M.D.,

    1. Modena Cancer Registry, Policlinico, Modena, Italy
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  • Lorenzo Gafà M.D.,

    1. Ragusa Cancer Registry, Ragusa, Italy
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  • Pascale Grosclaude Ph.D.,

    1. Tarn Cancer Registry, Recherche en Epidémiologie et Prévention, Albi, France
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  • Guy Hédelin Ph.D.,

    1. Bas-Rhin Cancer Registry, Laboratoire d'Epidémiologie et de Santé Publique, Faculté de Médecine, Strasbourg, France
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  • Josette Macè-Lesech M.Sc.,

    1. Calvados Cancer Registry, Centre François Baclesse, Caen, France
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  • Carmen Martinez Garcia M.D.,

    1. Granada Cancer Registry, Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain
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  • Henrik Møller D.M.,

    1. Thames Cancer Registry, London, United Kingdom
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  • Eugenio Paci M.D.,

    1. Tuscany Cancer Registry, U.O. di Epidemiologia Clinica e Descrittiva, Firenze, Italy
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  • Nicole Raverdy M.Sc.,

    1. Somme Cancer Registry, Association pour la Recherche Epidemiologique en Picardie, Amiens, France
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  • Brigitte Tretarre M.D.,

    1. Hérault Cancer Registry, Bât Recherche, Parc Euromédecine, Montpellier, France
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  • Evelyn M. I. Williams M.D.,

    1. Mersey Cancer Registry, University of Liverpool, Liverpool, United Kingdom
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  • European Concerted Action on Survival and Care of Cancer Patients (EUROCARE) Working Group

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    • The EUROCARE Working Group for the current study includes the following contributors: Estonia: T. Aareleid and A. Kupp (Estonian Cancer Registry); France: G. Hèdelin (Bas Rhin Cancer Registry), G. Chaplain (Côte d'Or Breast and Gynaecologic Cancer Registry), M. Colonna and C. Exbrayat (Isère Cancer Registry), B. Tretarre (Hérault Cancer Registry), P. Grosclaude (Tarn Cancer Registry), J. Macè-Lesech (Calvados General Cancer Registry), M. Mercier (Doubs Cancer Registry), and N. Raverdy (Somme Cancer Registry); Italy: E. Artioli and M. Federico (Modena Cancer Registry), A. Barchielli and E. Paci (Tuscan Cancer Registry), F. Berrino (Project Leader), G. Gatta, M. Sant, and C. Allemani (Istituto Nazionale per lo Studio e la Cura dei Tumori), P. Crosignani, D. Speciale, M. R. Ruzza, and E. Frassoldi (Lombardy Cancer Registry), R. Capocaccia and A. Verdecchia (Istituto Superiore di Sanità), and L. Gafà, R. Tumino, and M. La Rosa (Ragusa Cancer Registry); Spain: C. Martinez (Granada Cancer Registry); The Netherlands: J.W.W. Coebergh and A. Voogd (Eindhoven Cancer Registry); United Kingdom: J. Bell and H. Møller (Thames Cancer Registry), M.P. Coleman (London School of Hygiene and Tropical Medicine), and E.M.I. Williams and J. Youngson (Merseyside and Cheshire Cancer Registry).


Abstract

BACKGROUND

Breast carcinoma survival rates were found to be higher in the U.S. than in Europe.

METHODS

Multiple regression analysis of breast carcinoma survival rates among women diagnosed between 1990 and 1992 was performed using clinical data from population-based case series from the Surveillance, Epidemiogy, and End Results (SEER) program (13,172 women) and the European Concerted Action on survival and Care of Cancer Patients (EUROCARE) project (4478 women).

RESULTS

Early-stage tumors (T1N0M0) were more frequent in the SEER data (41% of cases) than in the EUROCARE data (29%). In the SEER data, early tumors were more frequent in women age ≥ 65 years (43%) than in younger women (38%), whereas the reverse was true in the European data (25% vs. 31%). In both case series, > 90% of women underwent surgery and 81–82% underwent lymphadenectomy, but the number of axillary lymph nodes evaluated was higher in the SEER data than in the EUROCARE data. The 5-year survival rate was higher in the U.S. case series (89%) than in the European series (79%). This differential was observed for each stage category evaluated: early (T1N0M0), large lymph node-negative (T2–3N0M0), lymph node-positive (T1–3N+M0), locally advanced (T4M0), and metastatic (M1) tumors. The overall relative excess risk (RER) of death was significantly higher (RER, 1.37; 95% confidence interval [95% CI], 1.25–1.50) among European women compared with U.S. women (referent group). Adjustment for stage, age, surgery, and the number of lymph nodes evaluated explained most of the excess risk (RER, 1.07; 95% CI, 0.98–1.17).

CONCLUSIONS

Transatlantic differences in the 5-year survival rates for women diagnosed with breast carcinoma between 1990 and 1992 were attributable mainly to differences in stage of disease. Resources should be invested to achieve earlier diagnosis of breast carcinoma in Europe, especially for elderly women. Cancer 2004;100:715–22. © 2003 American Cancer Society.

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