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Stage-specific survival has improved for young breast cancer patients since 2000: but not equally.

ABSTRACT: PURPOSE:The stage-specific survival of young breast cancer patients has improved, likely due to diagnostic and treatment advances. We addressed whether survival improvements have reached all socioeconomic groups in a country with universal health care and national treatment guidelines. METHODS:Using Norwegian registry data, we assessed stage-specific breast cancer survival by education and income level of 7501 patients (2317 localized, 4457 regional, 233 distant and 494 unknown stage) aged 30-48 years at diagnosis during 2000-2015. Using flexible parametric models and national life tables, we compared excess mortality up to 12 years from diagnosis and 5-year relative survival trends, by education and income as measures of socioeconomic status (SES). RESULTS:Throughout 2000-2015, regional and distant stage 5-year relative survival improved steadily for patients with high education and high income (high SES), but not for patients with low education and low income (low SES). Regional stage 5-year relative survival improved from 85 to 94% for high SES patients (9% change; 95% confidence interval: 6, 13%), but remained at 84% for low SES patients (0% change; - 12, 12%). Distant stage 5-year relative survival improved from 22 to 58% for high SES patients (36% change; 24, 49%), but remained at 11% for low SES patients (0% change; - 19, 19%). CONCLUSIONS:Regional and distant stage breast cancer survival has improved markedly for high SES patients, but there has been little survival gain for low SES patients. Socioeconomic status matters for the stage-specific survival of young breast cancer patients, even with universal health care.

SUBMITTER: Trewin CB

PROVIDER: S-EPMC7297859 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Stage-specific survival has improved for young breast cancer patients since 2000: but not equally.

Trewin Cassia Bree CB Johansson Anna Louise Viktoria ALV Hjerkind Kirsti Vik KV Strand Bjørn Heine BH Kiserud Cecilie Essholt CE Ursin Giske G

Breast cancer research and treatment 20200603 2

<h4>Purpose</h4>The stage-specific survival of young breast cancer patients has improved, likely due to diagnostic and treatment advances. We addressed whether survival improvements have reached all socioeconomic groups in a country with universal health care and national treatment guidelines.<h4>Methods</h4>Using Norwegian registry data, we assessed stage-specific breast cancer survival by education and income level of 7501 patients (2317 localized, 4457 regional, 233 distant and 494 unknown st ...[more]

PMID: 32495000

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Project description:BackgroundDuring the last part of the 1990s the chance of surviving breast cancer increased. Changes in survival functions reflect a mixture of effects. Both, the introduction of adjuvant treatments and early screening with mammography played a role in the decline in mortality. Evaluating the contribution of these interventions using mathematical models requires survival functions before and after their introduction. Furthermore, required survival functions may be different by age groups and are related to disease stage at diagnosis. Sometimes detailed information is not available, as was the case for the region of Catalonia (Spain). Then one may derive the functions using information from other geographical areas. This work presents the methodology used to estimate age- and stage-specific Catalan breast cancer survival functions from scarce Catalan survival data by adapting the age- and stage-specific US functions.MethodsCubic splines were used to smooth data and obtain continuous hazard rate functions. After, we fitted a Poisson model to derive hazard ratios. The model included time as a covariate. Then the hazard ratios were applied to US survival functions detailed by age and stage to obtain Catalan estimations.ResultsWe started estimating the hazard ratios for Catalonia versus the USA before and after the introduction of screening. The hazard ratios were then multiplied by the age- and stage-specific breast cancer hazard rates from the USA to obtain the Catalan hazard rates. We also compared breast cancer survival in Catalonia and the USA in two time periods, before cancer control interventions (USA 1975-79, Catalonia 1980-89) and after (USA and Catalonia 1990-2001). Survival in Catalonia in the 1980-89 period was worse than in the USA during 1975-79, but the differences disappeared in 1990-2001.ConclusionOur results suggest that access to better treatments and quality of care contributed to large improvements in survival in Catalonia. On the other hand, we obtained detailed breast cancer survival functions that will be used for modeling the effect of screening and adjuvant treatments in Catalonia.

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Stage-specific survival has improved for young breast cancer patients since 2000: but not equally.

Publications

Stage-specific survival has improved for young breast cancer patients since 2000: but not equally.

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