Breast cancer survival in the US and Europe: A CONCORD high-resolution study
Corresponding Author
Claudia Allemani
Cancer Research UK Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
Analytical Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
Tel.: +44-20-7927-2855
Lecturer in Cancer Epidemiology, Cancer Research UK Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UKSearch for more papers by this authorMilena Sant
Analytical Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
Search for more papers by this authorHannah K. Weir
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, MS-K53 Atlanta, GA
Search for more papers by this authorLisa C. Richardson
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, MS-K53 Atlanta, GA
Search for more papers by this authorPaolo Baili
Descriptive Studies and Health Planning Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
Search for more papers by this authorHans Storm
Department of Cancer Prevention and Documentation, Danish Cancer Society, Strandboulevarden 49, Copenhagen Ø, Denmark
Search for more papers by this authorSabine Siesling
Netherlands Cancer Registry, Comprehensive Cancer Center the Netherlands, 3501 DB Utrecht, The Netherlands
Search for more papers by this authorAna Torrella-Ramos
Cancer Registry Castellón (Comunitat Valenciana), Avenida del Mar 12, Castellón, Spain
Search for more papers by this authorAdri C. Voogd
Department of Research, Eindhoven Cancer Registry, 5600 AE Eindhoven, The Netherlands
Search for more papers by this authorTiiu Aareleid
Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
Search for more papers by this authorEva Ardanaz
Navarra Cancer Registry, Navarra Public Health Institute (CIBERESP), C Leyre 15, Pamplona, Navarra, Spain
Search for more papers by this authorFranco Berrino
Unit of Etiological Epidemiology and Prevention, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Search for more papers by this authorMagdalena Bielska-Lasota
Bioethics and Health Psychology Unit, Department of Health Promotion and Postgraduate Education, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland
Search for more papers by this authorSusan Bolick
South Carolina Central Cancer Registry, Columbia, SC
Search for more papers by this authorClaudia Cirilli
Modena Cancer Registry, Via Del Pozzo 71, Modena, Italy
Search for more papers by this authorMarc Colonna
Isère Cancer Registry, 21 Chemin des Sources, Meylan, France
Search for more papers by this authorPaolo Contiero
Cancer Registry and Environmental Epidemiology Unit, Fondazione IRCSS Istituto Nazionale Tumori, Via Venezian 1, Milan, Italy
Search for more papers by this authorRosemary Cress
Public Health Institute/California Cancer Registry, Sacramento, CA
Search for more papers by this authorEmanuele Crocetti
Tuscany Cancer Registry, UO Epidemiologia Clinica e Descrittiva, ISPO, Via di San Salvi 12, Firenze, Italy
Search for more papers by this authorPascale Grosclaude
Tarn Cancer Registry, Chemin des Trois Tarn, Albi, France
Search for more papers by this authorTimo Hakulinen
Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Pieni Roobertinkatu 9, Helsinki, Finland
Search for more papers by this authorM. Isabel Izarzugaza
Registros e Información Sanitaria, Dpto. de Sanidad del Gobierno Vasco, c Donostia-San Sebastian, Vitoria-Gasteiz, Spain
Search for more papers by this authorPer Malmström
Skåne Department of Oncology, Skåne University Hospital, Lund, Sweden
Search for more papers by this authorKarin Peignaux
Côte d'Or Breast and Gynecologic Cancer Registry, Center Georges-François Leclerc, Dijon, France
Search for more papers by this authorMaja Primic-Žakelj
Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Zaloska, Ljubljana, Slovenia
Search for more papers by this authorJadwiga Rachtan
Cracow Cancer Registry, Center of Oncology, M Skłodowska-Curie Memorial Institute, Garncarska 11, Krakow, Poland
Search for more papers by this authorChakameh Safaei Diba
National Cancer Registry of Slovakia, National Health Information Center, Lazaretska 26, Bratislava, Slovakia
Search for more papers by this authorMaria-José Sánchez
Andalusian School of Public Health (Granada, Spain) and CIBER de Epidemiología y Salud Pública, Madrid, Spain
Search for more papers by this authorAdele Traina
Department of Oncology, P.O. M. Ascoli, ARNAS-Civico, Palermo, Italy
Search for more papers by this authorLaufey Tryggvadottir
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Icelandic Cancer Registry, Skogarhlid 8, 125 Reykjavik, Iceland
Search for more papers by this authorRosario Tumino
Cancer Registry and Histopathology Unit, Civile-MP Arezzo Hospital, ASP Ragusa, Piazza Igea 1, Ragusa, Italy
Search for more papers by this authorMichel Velten
Laboratoire d'épidémiologie et de santé publique, Registre des cancers du Bas-Rhin, Faculté de médecine-Université de Strasbourg, 4 rue Kirschleger, Strasbourg, France
Search for more papers by this authorMarina Vercelli
UOS Epidemiologia Descrittiva, USM-IST (IRCCS Azienda Ospedaliera Universitaria San Martino—IST Istituto Nazionale per la Ricerca sul Cancro), Largo R Benzi, 10-CBA, Torre C1, Genova, Italy
Sez. Epidemiologia Descrittiva, Dipartimento di Scienze della Salute, Università di Genova, Via A. Pastore 1, USM-IST/UNIGE, Genova, Italy
Search for more papers by this authorAnne-Sophie Woronoff
Doubs Cancer Registry, University Hospital Besançon, 2 Place Saint-Jacques, Besançon Cédex, France
Search for more papers by this authorXiaocheng Wu
Louisiana Tumor Registry, LSUHSC School of Public Health, New Orleans, LA
Search for more papers by this authorMichel P. Coleman
Cancer Research UK Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
Search for more papers by this authorCorresponding Author
Claudia Allemani
Cancer Research UK Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
Analytical Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
Tel.: +44-20-7927-2855
Lecturer in Cancer Epidemiology, Cancer Research UK Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UKSearch for more papers by this authorMilena Sant
Analytical Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
Search for more papers by this authorHannah K. Weir
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, MS-K53 Atlanta, GA
Search for more papers by this authorLisa C. Richardson
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, MS-K53 Atlanta, GA
Search for more papers by this authorPaolo Baili
Descriptive Studies and Health Planning Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
Search for more papers by this authorHans Storm
Department of Cancer Prevention and Documentation, Danish Cancer Society, Strandboulevarden 49, Copenhagen Ø, Denmark
Search for more papers by this authorSabine Siesling
Netherlands Cancer Registry, Comprehensive Cancer Center the Netherlands, 3501 DB Utrecht, The Netherlands
Search for more papers by this authorAna Torrella-Ramos
Cancer Registry Castellón (Comunitat Valenciana), Avenida del Mar 12, Castellón, Spain
Search for more papers by this authorAdri C. Voogd
Department of Research, Eindhoven Cancer Registry, 5600 AE Eindhoven, The Netherlands
Search for more papers by this authorTiiu Aareleid
Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
Search for more papers by this authorEva Ardanaz
Navarra Cancer Registry, Navarra Public Health Institute (CIBERESP), C Leyre 15, Pamplona, Navarra, Spain
Search for more papers by this authorFranco Berrino
Unit of Etiological Epidemiology and Prevention, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Search for more papers by this authorMagdalena Bielska-Lasota
Bioethics and Health Psychology Unit, Department of Health Promotion and Postgraduate Education, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland
Search for more papers by this authorSusan Bolick
South Carolina Central Cancer Registry, Columbia, SC
Search for more papers by this authorClaudia Cirilli
Modena Cancer Registry, Via Del Pozzo 71, Modena, Italy
Search for more papers by this authorMarc Colonna
Isère Cancer Registry, 21 Chemin des Sources, Meylan, France
Search for more papers by this authorPaolo Contiero
Cancer Registry and Environmental Epidemiology Unit, Fondazione IRCSS Istituto Nazionale Tumori, Via Venezian 1, Milan, Italy
Search for more papers by this authorRosemary Cress
Public Health Institute/California Cancer Registry, Sacramento, CA
Search for more papers by this authorEmanuele Crocetti
Tuscany Cancer Registry, UO Epidemiologia Clinica e Descrittiva, ISPO, Via di San Salvi 12, Firenze, Italy
Search for more papers by this authorPascale Grosclaude
Tarn Cancer Registry, Chemin des Trois Tarn, Albi, France
Search for more papers by this authorTimo Hakulinen
Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Pieni Roobertinkatu 9, Helsinki, Finland
Search for more papers by this authorM. Isabel Izarzugaza
Registros e Información Sanitaria, Dpto. de Sanidad del Gobierno Vasco, c Donostia-San Sebastian, Vitoria-Gasteiz, Spain
Search for more papers by this authorPer Malmström
Skåne Department of Oncology, Skåne University Hospital, Lund, Sweden
Search for more papers by this authorKarin Peignaux
Côte d'Or Breast and Gynecologic Cancer Registry, Center Georges-François Leclerc, Dijon, France
Search for more papers by this authorMaja Primic-Žakelj
Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Zaloska, Ljubljana, Slovenia
Search for more papers by this authorJadwiga Rachtan
Cracow Cancer Registry, Center of Oncology, M Skłodowska-Curie Memorial Institute, Garncarska 11, Krakow, Poland
Search for more papers by this authorChakameh Safaei Diba
National Cancer Registry of Slovakia, National Health Information Center, Lazaretska 26, Bratislava, Slovakia
Search for more papers by this authorMaria-José Sánchez
Andalusian School of Public Health (Granada, Spain) and CIBER de Epidemiología y Salud Pública, Madrid, Spain
Search for more papers by this authorAdele Traina
Department of Oncology, P.O. M. Ascoli, ARNAS-Civico, Palermo, Italy
Search for more papers by this authorLaufey Tryggvadottir
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Icelandic Cancer Registry, Skogarhlid 8, 125 Reykjavik, Iceland
Search for more papers by this authorRosario Tumino
Cancer Registry and Histopathology Unit, Civile-MP Arezzo Hospital, ASP Ragusa, Piazza Igea 1, Ragusa, Italy
Search for more papers by this authorMichel Velten
Laboratoire d'épidémiologie et de santé publique, Registre des cancers du Bas-Rhin, Faculté de médecine-Université de Strasbourg, 4 rue Kirschleger, Strasbourg, France
Search for more papers by this authorMarina Vercelli
UOS Epidemiologia Descrittiva, USM-IST (IRCCS Azienda Ospedaliera Universitaria San Martino—IST Istituto Nazionale per la Ricerca sul Cancro), Largo R Benzi, 10-CBA, Torre C1, Genova, Italy
Sez. Epidemiologia Descrittiva, Dipartimento di Scienze della Salute, Università di Genova, Via A. Pastore 1, USM-IST/UNIGE, Genova, Italy
Search for more papers by this authorAnne-Sophie Woronoff
Doubs Cancer Registry, University Hospital Besançon, 2 Place Saint-Jacques, Besançon Cédex, France
Search for more papers by this authorXiaocheng Wu
Louisiana Tumor Registry, LSUHSC School of Public Health, New Orleans, LA
Search for more papers by this authorMichel P. Coleman
Cancer Research UK Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
Search for more papers by this authorAbstract
Breast cancer survival is reportedly higher in the US than in Europe. The first worldwide study (CONCORD) found wide international differences in age-standardized survival. The aim of this study is to explain these survival differences. Population-based data on stage at diagnosis, diagnostic procedures, treatment and follow-up were collected for about 20,000 women diagnosed with breast cancer aged 15–99 years during 1996–98 in 7 US states and 12 European countries. Age-standardized net survival and the excess hazard of death up to 5 years after diagnosis were estimated by jurisdiction (registry, country, European region), age and stage with flexible parametric models. Breast cancers were generally less advanced in the US than in Europe. Stage also varied less between US states than between European jurisdictions. Early, node-negative tumors were more frequent in the US (39%) than in Europe (32%), while locally advanced tumors were twice as frequent in Europe (8%), and metastatic tumors of similar frequency (5–6%). Net survival in Northern, Western and Southern Europe (81–84%) was similar to that in the US (84%), but lower in Eastern Europe (69%). For the first 3 years after diagnosis the mean excess hazard was higher in Eastern Europe than elsewhere: the difference was most marked for women aged 70–99 years, and mainly confined to women with locally advanced or metastatic tumors. Differences in breast cancer survival between Europe and the US in the late 1990s were mainly explained by lower survival in Eastern Europe, where low healthcare expenditure may have constrained the quality of treatment.
Abstract
What's new?
Most of the diagnostic and therapeutic modalities used for breast cancer more than 10 years ago remain in widespread use today. Understanding the extent to which access to those modalities can explain international differences in cancer survival therefore remains highly relevant. This is the largest population-based high-resolution study, with a common protocol, standard quality-control procedures and central analyses. The modelling approach to estimate net survival is a methodological strength.
Supporting Information
Additional Supporting Information may be found in the online version of this article.
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| JCC_27725_sm_SuppFig2.tif61.2 KB | Supporting Information Figure 2 |
| JCC_27725_sm_SuppFig3.tif62 KB | Supporting Information Figure 3 |
| JCC_27725_sm_SuppFig4.tif64.7 KB | Supporting Information Figure 4 |
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