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Declining mortality from breast cancer in Yorkshire, 1983-1998: extent and causes.

ABSTRACT: Incidence and mortality data, stage of disease and treatment information for female breast cancer were obtained for the years 1975-1999 for the former Yorkshire Regional Health Authority area, from the Northern and Yorkshire Cancer Registry and Information Service. Deaths by age group and 3-year calendar period were separated into those occurring among cases diagnosed 0-2 and 3-4 years preceding death (short- and medium-term survivors, respectively), and among longer-term survivors and age-adjusted rates were calculated separately by survival time. The 3-year survival of cases incident in 1991-1999 and in 1982-1990 were compared, adjusting for stage and treatment. Breast cancer mortality in Yorkshire stopped increasing around 1983 and has since consistently declined, primarily among short- and medium-term survivors. The 3-year survival was significantly improved in cases diagnosed in 1991-1999, compared with 1982-1990, in all age groups (hazard ratio (HR)=0.75, 95% c.l. 0.71-0.78). The improvement was least in the 65+ years age group (HR=0.83, 95% c.l. 0.79-0.88), intermediate in the youngest (<50 years) cases (HR=0.71, 95% c.l. 0.63-0.80) and greatest in the age group 50-64 years, offered routine screening after 1988 (HR=0.51, 95% c.l. 0.47-0.57). The benefit for cases diagnosed in the 1990s persisted, but was reduced after adjustment for stage in cases <65 years, while it disappeared in older cases (HR=1.01). Below age 65 years, the use of systemic therapy increased substantially, but did not explain the residual improvements in short-term prognosis. A greater decline in breast cancer mortality in Yorkshire from 1982 to 1984 was observed among short- and medium-term, than in longer-term, survivors. Much of the improvement in survival in cases <65 years could be attributed to a more favourable stage at diagnosis, whereas this accounted for nearly all the improvement in survival among older cases. Systemic therapy had little or no impact on 3-year survival. Continuing declines in mortality can be expected in the current decade, as a result of the long-term effects of both mammography screening and increased use of systemic therapy.

SUBMITTER: Pisani P

PROVIDER: S-EPMC2409595 | biostudies-other | 2004 Feb

REPOSITORIES: biostudies-other

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Project description:To evaluate trends in premature cancer mortality in Colombia by educational level in three periods: 1998-2002 with low healthcare insurance coverage, 2003-2007 with rapidly increasing coverage and finally 2008-2012 with almost universal coverage (2008-2012).Colombian population-based, national secondary mortality data.We included all (n=188,091) cancer deaths occurring in the age group 20-64 years between 1998 and 2012, excluding only cases with low levels of quality of registration (n=2902, 1.5%).In this descriptive study, we linked mortality data of ages 20-64 years to census data to obtain age-standardised cancer mortality rates by educational level. Using Poisson regression, we modelled premature mortality by educational level estimating rate ratios (RR), relative index of inequality (RII) and the Slope Index of Inequality (SII).Relative measures showed increased risks of dying among the lower educated compared to the highest educated; this tendency was stronger in women (RRprimary 1.49; RRsecondary 1.22, both p<0.0001) than in men (RRprimary 1.35; RRsecondary 1.11, both p<0.0001). In absolute terms (SII), cancer caused a difference per 100 000 deaths between the highest and lowest educated of 20.5 in males and 28.5 in females. RII was significantly higher among women and the younger age categories. RII decreased between the first and second periods; afterwards (2008-2012), it increased significantly back to their previous levels. Among women, no significant increases or declines in cancer mortality over time were observed in recent periods in the lowest educated group, whereas strong recent declines were observed in those with secondary education or higher.Educational inequalities in cancer mortality in Colombia are increasing in absolute and relative terms, and are concentrated in young age categories. This trend was not curbed by increases in healthcare insurance coverage. Policymakers should focus on improving equal access to prevention, early detection, diagnostic and treatment facilities.

Project description:ImportanceBilateral mastectomy is increasingly used to treat unilateral breast cancer. Because it may have medical and psychosocial complications, a better understanding of its use and outcomes is essential to optimizing cancer care.ObjectiveTo compare use of and mortality after bilateral mastectomy, breast-conserving therapy with radiation, and unilateral mastectomy.Design, setting, and participantsObservational cohort study within the population-based California Cancer Registry; participants were women diagnosed with stages 0-III unilateral breast cancer in California from 1998 through 2011, with median follow-up of 89.1 months.Main outcomes and measuresFactors associated with surgery use (from polytomous logistic regression); overall and breast cancer-specific mortality (from propensity score weighting and Cox proportional hazards analysis).ResultsAmong 189,734 patients, the rate of bilateral mastectomy increased from 2.0% (95% CI, 1.7%-2.2%) in 1998 to 12.3% (95% CI, 11.8%-12.9%) in 2011, an annual increase of 14.3% (95% CI, 13.1%-15.5%); among women younger than 40 years, the rate increased from 3.6% (95% CI, 2.3%-5.0%) in 1998 to 33% (95% CI, 29.8%-36.5%) in 2011. Bilateral mastectomy was more often used by non-Hispanic white women, those with private insurance, and those who received care at a National Cancer Institute (NCI)-designated cancer center (8.6% [95% CI, 8.1%-9.2%] among NCI cancer center patients vs 6.0% [95% CI, 5.9%-6.1%] among non-NCI cancer center patients; odds ratio [OR], 1.13 [95% CI, 1.04-1.22]); in contrast, unilateral mastectomy was more often used by racial/ethnic minorities (Filipina, 52.8% [95% CI, 51.6%-54.0%]; OR, 2.00 [95% CI, 1.90-2.11] and Hispanic, 45.6% [95% CI, 45.0%-46.2%]; OR, 1.16 [95% CI, 1.13-1.20] vs non-Hispanic white, 35.2% [95% CI, 34.9%-35.5%]) and those with public/Medicaid insurance (48.4% [95% CI, 47.8%-48.9%]; OR, 1.08 [95% CI, 1.05-1.11] vs private insurance, 36.6% [95% CI, 36.3%-36.8%]). Compared with breast-conserving surgery with radiation (10-year mortality, 16.8% [95% CI, 16.6%-17.1%]), unilateral mastectomy was associated with higher all-cause mortality (hazard ratio [HR], 1.35 [95% CI, 1.32-1.39]; 10-year mortality, 20.1% [95% CI, 19.9%-20.4%]). There was no significant mortality difference compared with bilateral mastectomy (HR, 1.02 [95% CI, 0.94-1.11]; 10-year mortality, 18.8% [95% CI, 18.6%-19.0%]). Propensity analysis showed similar results.Conclusions and relevanceUse of bilateral mastectomy increased significantly throughout California from 1998 through 2011 and was not associated with lower mortality than that achieved with breast-conserving surgery plus radiation. Unilateral mastectomy was associated with higher mortality than were the other 2 surgical options.

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Declining mortality from breast cancer in Yorkshire, 1983-1998: extent and causes.

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