Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Mar 19;108(5):1195-208.
doi: 10.1038/bjc.2013.6. Epub 2013 Feb 28.

Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000-2007: a population-based study

S Walters  1 , C Maringe, J Butler, B Rachet, P Barrett-Lee, J Bergh, J Boyages, P Christiansen, M Lee, F Wärnberg, C Allemani, G Engholm, T Fornander, M L Gjerstorff, T B Johannesen, G Lawrence, C E McGahan, R Middleton, J Steward, E Tracey, D Turner, M A Richards, M P Coleman; ICBP Module 1 Working Group
Collaborators, Affiliations

Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000-2007: a population-based study

S Walters et al. Br J Cancer. .

Abstract

Background: We investigate whether differences in breast cancer survival in six high-income countries can be explained by differences in stage at diagnosis using routine data from population-based cancer registries.

Methods: We analysed the data on 257,362 women diagnosed with breast cancer during 2000-7 and registered in 13 population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK. Flexible parametric hazard models were used to estimate net survival and the excess hazard of dying from breast cancer up to 3 years after diagnosis.

Results: Age-standardised 3-year net survival was 87-89% in the UK and Denmark, and 91-94% in the other four countries. Stage at diagnosis was relatively advanced in Denmark: only 30% of women had Tumour, Nodes, Metastasis (TNM) stage I disease, compared with 42-45% elsewhere. Women in the UK had low survival for TNM stage III-IV disease compared with other countries.

Conclusion: International differences in breast cancer survival are partly explained by differences in stage at diagnosis, and partly by differences in stage-specific survival. Low overall survival arises if the stage distribution is adverse (e.g. Denmark) but stage-specific survival is normal; or if the stage distribution is typical but stage-specific survival is low (e.g. UK). International differences in staging diagnostics and stage-specific cancer therapies should be investigated.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Proportions of breast cancer patients with missing stage (upper figure) and cumulative stage distribution among staged patients (lower figure). Results presented by age at diagnosis and country: TNM (left) and SEER Summary Stage 2000 (right). Notes: Denmark and Norway: national data; Australia: New South Wales; Canada: British Columbia and Manitoba; Sweden: Uppsala-Örebro and Stockholm-Gotland health regions; UK (TNM analysis): Northern Ireland, Wales and the Northern and Yorkshire Cancer Registry and Information Service, Eastern Cancer Registration and Information Centre, Oxford Cancer Intelligence Unit, West Midlands Cancer Intelligence Unit in England; UK (SEER SS2000 analysis): Northern Ireland and Wales. In Denmark, we analysed women diagnosed during 2004–7.
Figure 2
Figure 2
Age-standardised excess hazard of death (per 1000 person-years, log scale) from breast cancer. Results presented by TNM or SEER Summary Stage 2000 and time since diagnosis. Notes: (1) Denmark and Norway: national data; Australia: New South Wales; Canada: British Columbia and Manitoba; Sweden: Uppsala-Örebro and Stockholm-Gotland health regions; UK (TNM analysis): Northern Ireland, Wales and the Northern and Yorkshire Cancer Registry and Information Service, Eastern Cancer Registration and Information Centre, Oxford Cancer Intelligence Unit, West Midlands Cancer Intelligence Unit in England; UK (SEER SS2000 analysis): Northern Ireland and Wales. In Denmark, we analysed women diagnosed during 2004–7. (2) Bubbles are scaled to represent the stage distribution at diagnosis.
Figure 3
Figure 3
Age-standardised 1-year net survival for women diagnosed with breast cancer during 2000–7. Results presented by stage at diagnosis and country, using known stage and imputed stage: TNM (upper figure) and SEER Summary Stage 2000 (lower figure). x=survival estimate derived from women with known stage. =range of survival estimates derived for all women after imputation of stage where it was missing (see text). Notes: Denmark and Norway: national data; Australia: New South Wales; Canada: British Columbia and Manitoba; Sweden: Uppsala-Örebro and Stockholm-Gotland health regions; UK (TNM analysis): Northern Ireland, Wales and the Northern and Yorkshire Cancer Registry and Information Service, Eastern Cancer Registration and Information Centre, Oxford Cancer Intelligence Unit, West Midlands Cancer Intelligence Unit in England; UK (SEER SS2000 analysis): Northern Ireland and Wales. In Denmark, we analysed women diagnosed during 2004–7.
See this image and copyright information in PMC

References

    1. Allemani C, Sant M, Weir HK, Richardson LC, Baili P, Storm H, Siesling S, Torrella-Ramos A, Voogd AC, Aareleid T, Ardanaz E, Berrino F, Bielska-Lasota M, Bolick S, Cirilli C, Colonna M, Contiero P, Cress R, Crocetti E, Fulton JP, Grosclaude P, Hakulinen T, Izarzugaza MI, Malmstrom P, Peignaux K, Primic-Žakelj M, Rachtan J, Diba CS, Sanchez MJ, Schymura MJ, Shen T, Traina A, Tryggvadóttir L, Tumino R, Velten M, Vercelli M, Wolf HJ, Woronoff AS, Wu X, Coleman MP. Breast cancer survival in the US and Europe: a CONCORD high-resolution study. Int J Cancer. 2013;132 (5:1170–1181. - PMC - PubMed
    1. Allemani C, Storm H, Voogd AC, Holli K, Izarzugaza I, Torrella-Ramos A, Bielska-Lasota M, Aareleid T, Ardanaz E, Colonna M, Crocetti E, Danzon A, Federico M, Garau I, Grosclaude P, Hédelin G, Martinez-Garcia C, Peignaux K, Pleško I, Primic-Žakelj M, Rachtan J, Tagliabue G, Tumino R, Traina A, Tryggvadóttir L, Vercelli M, Sant M. Variation in ‘standard care' for breast cancer across Europe: a EUROCARE-3 high resolution study. Eur J Cancer. 2010;46 (9:1528–1536. - PubMed
    1. Autier P, Boniol M, Gavin A, Vatten LJ. Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database. BMJ. 2011;343:d4411. - PMC - PubMed
    1. Bastiaannet E, Liefers GJ, de Craen AJ, Kuppen PJ, van de Water W, Portielje JE, van der Geest LG, Janssen-Heijnen ML, Dekkers OM, van de Velde CJ, Westendorp RG. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127 805 unselected patients. Breast Cancer Res Treat. 2010;124 (3:801–807. - PubMed
    1. Berrino F, De Angelis R, Sant M, Rosso S, Bielska-Lasota M, Coebergh JW, Santaquilani M.EUROCARE Working Group (2007Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study Lancet Oncol 8(9773–783. - PubMed

Publication types