Henry G Kaplan1, Judith A Malmgren2,3, Mary K Atwood1, Gregory S Calip4. 1. Department of Oncology, Swedish Cancer Institute, Seattle, Washington. 2. HealthStat Consulting, Seattle, Washington. 3. Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington. 4. Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois.
Abstract
BACKGROUND: The extent to which improvements over time in breast cancer survival are related to earlier detection by mammography or to more effective treatments is not known. METHODS: At a comprehensive cancer care center, the authors conducted a retrospective cohort study of women ages 50 to 69 years who were diagnosed with invasive breast cancer (stages I through III) and were followed over 3 periods (1990-1994, 1995-1999, and 2000-2007). Data were abstracted from patient charts and included detection method, diagnosis, treatment, and follow-up for vital status in the institutional breast cancer registry (n = 2998). The method of detection was categorized as patient or physician detected or mammography detected. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 5-year disease-specific survival in relation to detection method and treatment factors, and differences in survival were analyzed using the Kaplan-Meier method. RESULTS: Fifty-eight percent of breast cancers were mammography detected, and 42% were patient or physician detected; 56% of tumors were stage I, 31% were stage II, and 13% were stage III. The average length of follow-up was 10.71 years. The combined 5-year disease-specific survival rate was 89% from 1990 to 1994, 94% from 1995 to 1999, and 96% from 2000 to 2007 (P < .001). In an adjusted model, mammography detection (HR, 0.43; 95% CI, 0.27-0.70), hormone therapy (HR, 0.47; 95% CI, 0.30-0.75), and taxane-containing chemotherapy (HR, 0.61; 95% CI, 0.37-0.99) were significantly associated with a decreased risk of disease-specific mortality. CONCLUSIONS: Better breast cancer survival over time was related to mammography detection, hormone therapy, and taxane-containing chemotherapy. Treatment improvements alone are not sufficient to explain the observed survival improvements over time.
BACKGROUND: The extent to which improvements over time in breast cancer survival are related to earlier detection by mammography or to more effective treatments is not known. METHODS: At a comprehensive cancer care center, the authors conducted a retrospective cohort study of women ages 50 to 69 years who were diagnosed with invasive breast cancer (stages I through III) and were followed over 3 periods (1990-1994, 1995-1999, and 2000-2007). Data were abstracted from patient charts and included detection method, diagnosis, treatment, and follow-up for vital status in the institutional breast cancer registry (n = 2998). The method of detection was categorized as patient or physician detected or mammography detected. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 5-year disease-specific survival in relation to detection method and treatment factors, and differences in survival were analyzed using the Kaplan-Meier method. RESULTS: Fifty-eight percent of breast cancers were mammography detected, and 42% were patient or physician detected; 56% of tumors were stage I, 31% were stage II, and 13% were stage III. The average length of follow-up was 10.71 years. The combined 5-year disease-specific survival rate was 89% from 1990 to 1994, 94% from 1995 to 1999, and 96% from 2000 to 2007 (P < .001). In an adjusted model, mammography detection (HR, 0.43; 95% CI, 0.27-0.70), hormone therapy (HR, 0.47; 95% CI, 0.30-0.75), and taxane-containing chemotherapy (HR, 0.61; 95% CI, 0.37-0.99) were significantly associated with a decreased risk of disease-specific mortality. CONCLUSIONS: Better breast cancer survival over time was related to mammography detection, hormone therapy, and taxane-containing chemotherapy. Treatment improvements alone are not sufficient to explain the observed survival improvements over time.
Authors: Hadi Yaziji; Lynn C Goldstein; Todd S Barry; Robert Werling; Harry Hwang; Georgiana K Ellis; Julie R Gralow; Robert B Livingston; Allen M Gown Journal: JAMA Date: 2004-04-28 Impact factor: 56.272
Authors: I Craig Henderson; Donald A Berry; George D Demetri; Constance T Cirrincione; Lori J Goldstein; Silvana Martino; James N Ingle; M Robert Cooper; Daniel F Hayes; Katherine H Tkaczuk; Gini Fleming; James F Holland; David B Duggan; John T Carpenter; Emil Frei; Richard L Schilsky; William C Wood; Hyman B Muss; Larry Norton Journal: J Clin Oncol Date: 2003-03-15 Impact factor: 44.544
Authors: G van Schoor; S M Moss; J D M Otten; R Donders; E Paap; G J den Heeten; R Holland; M J M Broeders; A L M Verbeek Journal: Br J Cancer Date: 2011-02-22 Impact factor: 7.640
Authors: Jeroen Blommaert; Gwen Schroyen; Mathieu Vandenbulcke; Ahmed Radwan; Ann Smeets; Ron Peeters; Charlotte Sleurs; Patrick Neven; Hans Wildiers; Frédéric Amant; Stefan Sunaert; Sabine Deprez Journal: Hum Brain Mapp Date: 2019-08-21 Impact factor: 5.038
Authors: Jin You Kim; Jin Joo Kim; Lee Hwangbo; Hie Bum Suh; Ji Won Lee; Nam Kyung Lee; Ki Seok Choo; Suk Kim Journal: Br J Radiol Date: 2021-10-05 Impact factor: 3.039
Authors: Megan E Renna; M Rosie Shrout; Annelise A Madison; Maryam Lustberg; Stephen P Povoski; Doreen M Agnese; Raquel E Reinbolt; Robert Wesolowski; Nicole O Williams; Bhuvaneswari Ramaswamy; Sagar D Sardesai; Anne M Noonan; Jeffrey B VanDeusen; William B Malarkey; Janice K Kiecolt-Glaser Journal: J Behav Med Date: 2020-11-01