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. 2018 Jul;119(1):121-129.
doi: 10.1038/s41416-018-0090-1. Epub 2018 Jun 7.

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group

Marloes G M Derks  1 , Esther Bastiaannet  1   2 , Mandy Kiderlen  1 , Denise E Hilling  1 , Petra G Boelens  1 , Paul M Walsh  3 , Elizabeth van Eycken  4 , Sabine Siesling  5 , John Broggio  6 , Lynda Wyld  7 , Maciej Trojanowski  8 , Agnieszka Kolacinska  9 , Justyna Chalubinska-Fendler  10 , Ana Filipa Gonçalves  11 , Tomasz Nowikiewicz  12 , Wojciech Zegarski  12 , Riccardo A Audisio  13 , Gerrit-Jan Liefers  1 , Johanneke E A Portielje  14 , Cornelis J H van de Velde  15 ; EURECCA Breast Cancer Group
Affiliations

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group

Marloes G M Derks et al. Br J Cancer. 2018 Jul.

Abstract

Background: Older patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival.

Methods: Population-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated.

Results: In total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6% (Netherlands) to 84.6% (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30-6.72, P < .001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium.

Conclusions: There is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart. Bilateral tumours: in case of synchronous tumours, the smallest stage tumour was excluded
Fig. 2
Fig. 2
Proportion of patients receiving treatment and adjusted relative excess risks (RERs) of death by stage of disease. Proportions of patients receiving therapy and adjusted relative excess risks (RER) of death by country for patients with stage I a, stage II b, or stage III c breast cancer. Countries were ranked according to the sum of proportions of each given treatment and the country with the highest sum of given treatment was assigned as reference country. Breast surgery: % of patients receiving any type of breast surgery; axillary surgery: % of patients receiving axillary surgery if they received any type of breast surgery; radiotherapy: % of patients receiving radiotherapy if they have received breast-conserving surgery; endocrine therapy: % of patients receiving endocrine therapy if they have received any type of breast surgery; chemotherapy: % of patients receiving chemotherapy if they have received any type of breast surgery. Error bars represent 95% confidence intervals. RER was adjusted for the following variables: age, year of diagnosis, grade, and morphology
Fig. 3
Fig. 3
Proportion of patients receiving breast surgery, primary endocrine therapy or no therapy by stage of disease
See this image and copyright information in PMC

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