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. 2025 Mar 31:15:1465511.
doi: 10.3389/fonc.2025.1465511. eCollection 2025.

Improvement in breast cancer survival across molecular subtypes in Hungary between 2011 and 2020: a nationwide, retrospective study

Miklós Darida #  1 , Gábor Rubovszky #  2 , Zoltán Kiss  1   3 , Borbála Székely  2 , Balázs Madaras  2 , Zsolt Horváth  4 , Judit Kocsis  4 , István Sipőcz  5 , Máté Várnai  1 , Éva Balogh  1 , Krisztina Kovács  1 , Viktória Buga  1 , Eugenia Karamousouli  6 , Tamás G Szabó  1 , György Rokszin  7 , Ibolya Fábián  7   8 , István Kenessey  9   10 , András Wéber  10 , Péter Nagy  11   12   13 , Zsófia Barcza  14 , Krisztina Bogos  15 , Zoltán Vokó #  16   17 , Csaba Polgár #  18   19
Affiliations

Improvement in breast cancer survival across molecular subtypes in Hungary between 2011 and 2020: a nationwide, retrospective study

Miklós Darida et al. Front Oncol. .

Abstract

Background: Despite well-documented clinical differences across breast-cancer (BC) molecular subtypes and relevant changes in therapeutic interventions over the past decades, there remains a significant lack of up-to-date epidemiologic data and real-world outcomes, particularly in Central and Eastern Europe.

Methods: This was a nationwide, retrospective study using the claims databases of the Hungarian National Health Insurance Fund (NHIF) that included patients who were newly diagnosed with BC between 2011 and 2020. BC subtypes were defined based on the therapies received. Overall survival (OS) and net survival rates were calculated.

Results: Between 2011 and 2020, 74,143 patients were newly diagnosed with BC based on ICD-10 diagnostic codes in the NHIF database and 80.1% of the cases could be classified into subtypes based on therapy. The most common subtype was HER2-/HR+ BC, identified in 61.9% of patients, followed by triple negative breast cancer (TNBC) in 8.4%, HER2+/HR+ BC in 6.2%, and HER2+/HR- BC in 3.6% of cases. The proportions of TNBC and HER2+/HR+ were higher among younger patients, than in elderly cohorts. The 5-year OS of the total BC population was 74.2% in patients diagnosed between 2015-2019. Patients with TNBC had the poorest 5-year OS (TNBC: 61.4%; HER2+/HR+: 86.5%; HER2-/HR+: 79.1%; HER2+/HR-: 71.9%). Net survival rates (i.e. survival rates after adjusting the effects of other causes of death) varied across diagnostic periods and molecular subtypes. In most cases, patients diagnosed later during the study period tended to have numerically better survival rates. Patients with HER2-/HR+ BC had the most favorable net survival, with 5-year net survival exceeding 92% during the whole observation period, while TNBC patients had the lowest 5-year net survival rates ranging between 63.6% and 65.8% during the study period.

Conclusion: Our nationwide study describes the distribution and survival of BC patients with different subtypes based on a retrospective analysis of the health insurance fund database. There remains a significant room for improvement in the survival of more aggressive molecular subtypes including HR-/HER2+ and triple-negative BC, which are more common in younger age cohorts.

Keywords: breast cancer; breast cancer subtypes; epidemiology; nationwide; retrospective; survival.

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Conflict of interest statement

Authors MD, ZK, VB, MV, ÉB, TS and KK are employees of MSD, Hungary, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, who may own stock and/or hold stock options in Merck & Co., Inc., Rahway, NJ, USA. EK is employee of MSD subsidiaries of Merck & Co., Inc., Rahway, NJ, USA and may own stocks and/or stock options in Merck & Co., Inc., Rahway, NJ, USA. ZV is an employee of Semmelweis University. Semmelweis University received a grant from MSD Hungary to contribute to this research. GR and IF are employees of RxTarget Ltd. and ZB is employed of Syntesia Ltd. where their contribution to this project was financially compensated. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declare that this study received funding from MSD Hungary. The funder had the following involvement with the study: in study design, data collection and analysis, decision to publish, and preparation of the manuscript.

Figures

Figure 1
Figure 1
Proportion of BC subtypes by age group (A) and proportion of TNBC patients receiving systemic therapy in different settings (neoadjuvant, adjuvant, other systemic therapy not falling in the previous 2 categories) (B) in the 2015-2019 diagnostic cohorts. BC, breast cancer; HER2, human epidermal growth factor receptor 2; HR, hormone receptor; TNBC, triple-negative breast cancer.
Figure 2
Figure 2
Overall survival of Hungarian BC patients diagnosed between 2015–2019 by cancer subtypes (A) and in the TNBC group by treatment strategies (surgery followed by adjuvant systemic treatment; neoadjuvant systemic treatment followed by surgery) (B). BC, breast cancer; HER2, human epidermal growth factor receptor 2; HR, hormone receptor; TNBC, triple-negative breast cancer.
Figure 3
Figure 3
5-year overall survival for patients with triple-negative BC undergoing peri-operative systemic treatment by treatment strategy applied (adjuvant or neoadjuvant) and different diagnostic periods (from 2011–2012 to 2017-2018). Error bars represent 95% confidence intervals.
Figure 4
Figure 4
One- to 5-year net survival estimates for patients with HER2–/HR+ (A), HER2+/HR– (B), TNBC (C), and HER2+/HR+ (D), by different periods (from 2011–12 to 2020, survival rates for a given cohort is provided up to the longest follow-up time within the observation period). Error bars represent 95% confidence intervals. BC, breast cancer; HER2, human epidermal growth factor receptor 2; HR, hormone receptor; TNBC, triple-negative breast cancer.
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