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. 2004 Jul 19;91(2):242-7.
doi: 10.1038/sj.bjc.6601969.

Trends in the usage of adjuvant systemic therapy for breast cancer in the Netherlands and its effect on mortality

M M Vervoort  1 , G Draisma, J Fracheboud, L V van de Poll-Franse, H J de Koning
Affiliations

Trends in the usage of adjuvant systemic therapy for breast cancer in the Netherlands and its effect on mortality

M M Vervoort et al. Br J Cancer. .

Abstract

Adjuvant systemic therapy was introduced in the Netherlands as a breast cancer treatment in the early 1980s. In this paper, we describe the trends in the usage of adjuvant systemic treatment in the period 1975-1997 in the Netherlands. The main aim of our study was to assess the effects of adjuvant tamoxifen and polychemotherapy on breast cancer mortality, compared to the effects of the mammography screening programme. The computer simulation model MIcrosimulation SCreening ANalysis, which simulates demography, natural history of breast cancer and screening effects, was used to estimate the effects. Use of adjuvant therapy increased over time, but since 1990 it remained rather stable. Nowadays, adjuvant therapy is given to 88% of node-positive patients aged 50-69 years, while less than 10% of node-negative patients receive any kind of adjuvant treatment. Adjuvant treatment is given independent of the mode of detection (adjusted by nodal status and size). We predict that the reduction in breast cancer mortality due to adjuvant therapy is 7% in women aged 55-74 years, while the reduction due to screening, which was first implemented in women aged 50-69 years in 1990-97, will be 28-30% in 2007. In conclusion, although adjuvant systemic therapy can reduce breast cancer mortality rates, it is anticipated to be less than the mortality reduction caused by mammography screening.

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Figures

Figure 1
Figure 1
(A–C) Trends in the usage of tamoxifen and chemotherapy in 1975–97 in the Southeast region (ECR) and all regions of the Netherlands (NE), subdivided by age (source: Eindhoven Cancer Registry and NETB).
Figure 2
Figure 2
Breast cancer mortality rates predicted by MISCAN for effects of screening and adjuvant therapy (chemotherapy and tamoxifen). (A) Age group 45–54 (assumed first screening attendance rate of 79% in the age group 50–54). (B) Age group 55–64 (assumed first screening attendance rate of 76–79% in the age group 55–64). (C) Age group 65–74 (assumed first screening attendance rate of 72–74% in the age group 65–69).
See this image and copyright information in PMC

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