- Email: [email protected]
Breast cancer survival in the US and Europe: a CONCORD high-resolution study
Breast cancer survival in the US and Europe: a CONCORD highresolution study Allemani C, Sant M, Weir HK, et al (London School of Hygiene and Tropical Medicine, UK; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Ctrs for Disease Control and Prevention, Atlanta, GA; et al) Int J Cancer 132:1170-1181, 2013
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 15e99 years during 1996e98 in 7 US states and 12 European countries. Agestandardized 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 (5e6%). Net survival in Northern, Western and Southern Europe (81e84%) 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 70e99 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. Breast cancer incidence and mortality rates vary widely around the world. The reasons are probably multifactorial and include life expectancy, nutritional status, lifestyle, biology, and access to and quality of care. Europe represents a microcosm of the world, with some very prosperous countries with full access and high-quality care and
others where access is severely limited and the quality of care is variable depending on health care expenditures. This analysis by Allemani and colleagues confirms the previously described variability in outcomes among various countries in Europe and points out similar variability in 5-year survival rates in the United States. Although the overall 5-year survival rate in the United States was 84%, the regional rate ranged from 76% to 92%. The 5-year survival rate in Northern European was 84% too, but the European regional range was even broader: 61% to 88%. This finding illustrates the enormous impact of access to care, health care system structure, and the attention society pays to its most vulnerable members. While we are justifiably proud of the quality of our health care in the United States, it only applies to individuals who have good insurance policies and live in the more enlightened regions. For others, the quality of our health care is no better than that of many developing nations. G. N. Hortobagyi, MD
Breast Diseases: A Year BookÒ Quarterly Vol 24 No 3 2013
223
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 15e99 years during 1996e98 in 7 US states and 12 European countries. Agestandardized 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 (5e6%). Net survival in Northern, Western and Southern Europe (81e84%) 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 70e99 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. Breast cancer incidence and mortality rates vary widely around the world. The reasons are probably multifactorial and include life expectancy, nutritional status, lifestyle, biology, and access to and quality of care. Europe represents a microcosm of the world, with some very prosperous countries with full access and high-quality care and
others where access is severely limited and the quality of care is variable depending on health care expenditures. This analysis by Allemani and colleagues confirms the previously described variability in outcomes among various countries in Europe and points out similar variability in 5-year survival rates in the United States. Although the overall 5-year survival rate in the United States was 84%, the regional rate ranged from 76% to 92%. The 5-year survival rate in Northern European was 84% too, but the European regional range was even broader: 61% to 88%. This finding illustrates the enormous impact of access to care, health care system structure, and the attention society pays to its most vulnerable members. While we are justifiably proud of the quality of our health care in the United States, it only applies to individuals who have good insurance policies and live in the more enlightened regions. For others, the quality of our health care is no better than that of many developing nations. G. N. Hortobagyi, MD
Breast Diseases: A Year BookÒ Quarterly Vol 24 No 3 2013
223