Small but significant excess mortality compared with the general population for long-term survivors of breast cancer in the Netherlands

BackgroundCoinciding with the relatively good and improving prognosis for patients with stage I–III breast cancer, late recurrences, new primary tumours and late side-effects of treatment may occur. We gained insight into prognosis for long-term breast cancer survivors.Patients and methodsData on all 205 827 females aged 15–89 diagnosed with stage I–III breast cancer during 1989–2008 were derived from the Netherlands Cancer Registry. Conditional 5-year relative survival was calculated for every subsequent year from diagnosis up to 15 years.ResultsFor stage I, conditional 5-year relative survival remained ∼95% up to 15 years after diagnosis (a stable 5-year excess mortality rate of 5%). For stage II, excess mortality remained 10% for those aged 15–44 or 45–59 and 15% for those aged 60–74. For stage III, excess mortality decreased from 35% at diagnosis to 10% at 15 years for those aged 15–44 or 45–59, and from ∼40% to 30% for those aged ≥60.ConclusionsPatients with stage I or II breast cancer had a (very) good long-term prognosis, albeit exhibiting a small but significant excess mortality at least up to 15 years after diagnosis. Improvements albeit from a lower level were mainly seen for patients who had been diagnosed with stage III disease. Caregivers can use this information to better inform (especially disease-free) cancer survivors about their actual prognosis.     

Survival of in situ carcinoma of cervix uteri: a 50-year follow-up in Finland

Preinvasive lesions of cervix uteri are regarded a curable disease despite some progression to invasive cancer. The ultimate outcome is not known. We estimated the 45-year survival of 12,655 patients with carcinoma in situ lesions diagnosed in 1953-2000 and reported to the Finnish Cancer Registry. Up to 30 years of follow-up there was about 1% decrease in cumulative relative survival per 5 years of follow-up. After that the excess mortality increased and the survival at 45 years was 84%. The 15-year survival was 100% in the patients under 30 at diagnosis and became the poorer the older the patient. Survival was 89% in the patients 60-74 at diagnosis. Women with carcinoma in situ are at substantial increased risk of death (>10%) only at high ages and independent of age at diagnosis.     

Cancer prevalence estimates in Italy from 1970 to 2010

AIMS AND BACKGROUND: The growing number of cancer survivors in Italy is expected to continue to increase as a consequence of population aging and survival improvements, but few estimates are currently available, particularly on the national and regional scale. The purpose of this work is to present detailed and updated prevalence estimates in Italy over the period 1970-2010 by cancer site (all cancers combined, stomach, colon and rectum, lung, breast and prostate) and gender. METHODS: Prevalence was derived with the MIAMOD statistical method, using cancer-specific mortality and relative survival as input data. Survival data from the Italian cancer registries were modeled to derive a national estimate for each cancer site and sex. To estimate prevalence trends, survival was assumed to improve in the future with the same rate observed in the period 1978-1994. A double scenario for survival--increasing or stationary--was considered to decompose the prevalence growth from 1995 to 2005 by its determinants: demographic changes, incidence and survival dynamics. The prevalence estimates were also decomposed by disease duration (2, 5 and 10 years) and by age (0-44, 45-59, 60-74 and 75-99). RESULTS: The proportion of cancer survivors in 2010 is expected to be about 4% in women and 3% in men, about twice the values attained in 1990. The highest dynamics was observed for prostate cancer, with a three-fold increase just in the 1995-2005 period (from 212 to 623 per 100,000), whereas in absolute terms breast cancer presented the highest levels (1700 per 100,000 in 2010). The overall number of cancer prevalent cases is expected to rise by about 48% in the decennium 1995-2005 (from 1,152,000 to 1,709,000), and this growth is mainly attributable to incidence dynamics (+21%), then to survival improvements (+14%) and population aging (13%). In 2005, the 2-year prevalent cases were estimated to be 20% of all cancer survivors, 21% between 2 and 5 years from the diagnosis, 23% between 5 and 10 years, with 36% surviving for more than 10 years. Prevalence proportion was very high in the elderly (12.6% for 75-84 years and 8% for 60-74 years). CONCLUSIONS: Updated prevalence data with appropriate coverage of the national territory are essential to define priorities in health care management and to develop cancer control programs. Prevalence by disease duration and by age should be the basis for planning research on the quality of life of cancer survivors, as long as cancer continues to become an even more chronic disease.     

Time trends in cancer incidence in Osaka

Changes in environments and life styles in Japan have caused the recent changes in the time trends of cancer incidence for various sites. Using the data from the Osaka Cancer Registry, time trends during 1966-80 were analysed for cancer incidence of the leading 5 sites: stomach, lung, liver, uterus and breast. Age-adjusted incidence rates of cancers of the stomach (both sexes) and uterus (invasive cancer) decreased to 75% and 64% respectively between the two periods of 1966-68 and 1978-80 while cancers of the lung, liver, and breast reached 163%, 140%, and 143 % during the same period. Decrease of stomach cancer incidence was observed in all age-groups under 79, however, not in the 25-44 age-groups among females. Analyzing the histological data in the registry, it was noticed that estimated incidence of the intestinal type of stomach carcinoma had decreased more rapidly than the diffuse type. In the 30-49 age-groups among females, no decrease was observed of the diffuse type of carcinoma. Concerning lung cancer, a marked increase was observed over 60 years of age. The age-specific incidence curves by birth cohort showed no or very small cohort effects for the population born 1920-29. Among males, percentages of adenocarcinoma and undifferentiated carcinoma have increased and that of epidermoid carcinoma decreased. The change was more marked in the age-groups younger than 59. Liver cancer showed the 3rd highest incidence rate among males and 6th among females. A rising trend in recent years was noticeable over 45 years of age among males. For the invasive uterine carcinoma, the incidence rate has been decreasing in all ages. Comparing these figures with those of whites in Connecticut or of Japanese in Hawaii, the former was higher than the latter and the difference was larger in age-groups over 40. The recent age incidence curve of breast cancer in Osaka came to be close to that in Iceland in 1930-49 when the curve had kept a constant level for age-groups after menopause. Birth cohort effect was observed for in these age classes.     

Standardized Breast Cancer Mortality Rate Compared to the General Female Population of Iran

Introduction: Breast cancer is the most common cancer in women. Improvements of early diagnosis modalitieshave led to longer survival rates. This study aimed to determine the 5, 10 and 15 year mortality rates of breastcancer patients compared to the normal female population. Materials and Methods: The follow up data of acohort of 615 breast cancer patients referred to Iranian Breast Cancer Research Center (BCRC) from 1986to 1996 was considered as reference breast cancer dataset. The dataset was divided into 5 year age groups andthe 5, 10 and 15 year probability of death for each group was estimated. The annual mortality rate of Iranianwomen was obtained from the Death Registry system. Standardized mortality ratios (SMRs) of breast cancerpatients were calculated using the ratio of the mortality rate in breast cancer patients over the general femalepopulation. Results: The mean age of breast cancer patients at diagnosis time was 45.9 (±10.5) years rangingfrom 24-74. A total of 73, 32 and 2 deaths were recorded at 5, 10 and 15 years, respectively, after diagnosis. TheSMRs for breast cancer patients at 5, 10 and 15 year intervals after diagnosis were 6.74 (95% CI, 5.5- 8.2), 6.55(95%CI, 5-8.1) and 1.26 (95%CI, 0.65-2.9), respectively. Conclusion: Results showed that the observed mortalityrate of breast cancer patients after 15 years from diagnosis was very similar to expected rates in general femalepopulation. This finding would be useful for clinicians and health policy makers to adopt a beneficial strategy toimprove breast cancer survival. Further follow-up time with larger sample size and a pooled analysis of survivalrates of different centres may shed more light on mortality patterns of breast cancer.     

Population-based study of breast cancer survival in Cote d'Or (France): prognostic factors and relative survival.

BACKGROUND: Few population-based studies have reported jointly analyses of relative survival according to the following prognostic factors: tumour-node-metastasis (TNM) stage, age, number of examined and positive nodes, hormonal status, histological Scarff, Bloom and Richardson (SBR) grade, tumour extension, hormone receptor status and tumour multifocal status. PATIENTS AND METHODS: Data on female invasive breast cancer were provided by the Cote d'Or breast cancer registry. The Kaplan-Meier method and log-rank test were used to estimate and compare the survival probability at 1, 5, 10 and 15 years. The effect of prognostic factors on survival was assessed with crude and relative multivariate survival analyses. RESULTS: Crude survival seemed to be worse in patients aged >60 years compared with those aged 45-60 (P > 0.0001), whereas relative survival did not differ. TNM stage, histological SBR grade, progesterone receptor status, tumour multifocal status, locoregional extension and the period of diagnosis were independent prognostic factors of crude and relative survival. CONCLUSION: Breast cancer is influenced by many factors. Despite the absence of any association between the number of examined nodes and overall survival in this study, the number of nodes removed, in conjunction with other prognostic factors, may be useful in selecting node-negative patients for systemic therapy.     

Specialisation and breast cancer survival in the screening era

It is recommended that specialist surgeons treat all breast cancer, although the limited evidence to support this is based on treatment patterns prior to the introduction of screening. Whether a specialist survival advantage exists in the post-screening era is uncertain, as referral and treatment patterns may have changed, in addition to the effect of screening on the natural history of breast cancer. Our aim was to determine the impact of screening on the caseload and case-mix of specialist surgeons, to determine if the survival advantage associated with specialist care is maintained with longer follow-up and persists after the introduction of screening. Using the West of Scotland Cancer Registry, all 7197 women treated for breast cancer in a 15-year time period (1980-1994) in a geographically defined cohort were followed up for an average of 9 years, and pathological stage and socioeconomic status were linked with mortality data. We show that the caseload of specialists has increased substantially (from 11 to 59% of the total workload) and that smaller cancers have been selectively referred. However, even after allowing for pathological stage, socioeconomic status and method of detection, specialist treatment was associated with a significantly lower risk of dying (prescreening: relative risk of dying=0.83, 95% CI=0.75-0.92; post-screening: relative risk of dying=0.89, 95% CI=0.78-1.00). We conclude that this survival benefit is most consistent with effective surgical management rather than selective referral, the influx of screen-detected cancers or adjuvant therapies.     

Improvement in survival of patients with cancer of the kidney in Europe

Survival of adult patients with cancer of the kidney, renal pelvis, ureter and urethra (ICD-9 189) was analysed using data from the EUROCARE II study, a collaborative project of 45 population-based cancer registries in 17 European countries. For the period 1985-1989, more than 24000 patients were included and 5-year relative survival was 48%. Large variations were observed between countries with 5-year relative survival ranging from 57% in France, 53% in Italy and 51% in Spain to 35% in Denmark, 33% in Poland and 30% in Estonia. A number of registries also provided information on previous years and survival was seen to improve with time from 44% in 1978-1980 to 50% in 1987-1989. Age was an important determinant of survival with 5 year survival rates decreasing from 63% in patients aged 15-44 years to 36% in patients aged 75 years and older. Variation in survival rates by country or time is probably related to differences in the distribution of tumour stage at diagnosis. Evidence to confirm this theory is, however, lacking.     

Variation in survival for adults with Nasopharyngeal cancer in Europe, 1978–1989

During the period 1978-1989, 2,054 new patients with nasopharyngeal carcinoma (NPC) were registered in the EUROCARE study, which, during 1985-1989 involved 45 population-based cancer registries in 17 countries. The follow-up time was at least 5 years. 48% of all cases were squamous cell carcinomas and 39% undifferentiated carcinomas, which were more frequent in males. The overall relative 1- and 5-year survival rates (data included from 8 countries with complete data) were 75 and 34%, respectively, for males, and 72 and 32%, respectively, for females, but in a multivariate analysis, there was no significant difference in risk between males and females (0.93 (0.84-1.01), hazard ratio (HR) with 95% confidence interval (95% CI) for females). The overall relative 5-year survival (data included from nine countries with complete data) declined with age, from 53% for patients aged 15-44 years to 31% for patients aged 65-74 years. For patients with undifferentiated tumours, higher survival rates were observed in Scandinavia, Slovakia and Mediterranean countries, with lower rates for patients from the U.K. and Estonia. Survival for patients with squamous cell carcinoma was lowest in Scotland, England and Estonia. In a multivariate analysis, there was a significant difference in risk of death between those with squamous cell carcinomas and those with undifferentiated (HR 0.82, 95% CI 0.74-0.90). Between 1978 and 1989, the prognosis did not change.     

Prognosis for long-term survivors of cancer.

BACKGROUND: Many cancer patients who have already survived some time want to know about their prognosis, given the pre-condition that they are still alive. We described and interpreted population-based conditional 5-year relative survival rates. PATIENTS AND METHODS: The long-standing Eindhoven Cancer Registry collects data on all patients diagnosed with cancer in the southern part of the Netherlands. Patients aged 25-74 years, diagnosed between 1960 and 2004, were included. Conditional 5-year relative survival was computed for every additional year survived (follow-up period 1980-2004). RESULTS: For patients with colorectal cancer, cutaneous melanoma or stage I breast cancer, conditional 5-year relative survival was >95% after having survived 3-15 years. However, for stomach, lung, stage II or III breast, prostate cancer or Hodgkin lymphoma, conditional 5-year relative survival did not exceed 75-94%. Initial differences in survival at diagnosis between age, gender and stage groups largely disappeared after having survived for 5-10 years. CONCLUSION: Prognosis for patients with cancer generally improved with each year survived. Patients with colorectal cancer, cutaneous melanoma or stage I breast cancer hardly exhibit any excess mortality after 3-15 years, whereas for patients with other tumours survival remained poorer than for the general population. Insight into conditional survival is especially useful for (ex)patients, who may use this information to plan their remaining life.     

Survival of cervical cancer patients in Germany in the early 21st century: A period analysis by age, histology, and stage

Abstract Purpose. Population-based studies on cervical cancer providing survival estimates by age, histology, and stage have been sparse. We aimed to derive most up-to-date and detailed survival estimates for cervical cancer patients in Germany. Methods. We used a pooled German national dataset including data from 11 cancer registries covering a population of 33 million people. Included were 15 685 patients diagnosed with cervical cancer from 1997 to 2006. Period analysis was performed to calculate the five-year relative survival (RS) 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age-adjustment was done using five age groups (15-44, 45-54, 55-64, 65-74, and 75 + years). Results. Overall, age-adjusted five-year relative survival in 2002-2006 was 64.7%. A strong age gradient was observed, with five-year RS decreasing from 81.7% in age group 15-49 years to 46.3% in age group 70 + years. Prognosis furthermore strongly varied by stage, with age-adjusted five-year RS reaching 84.6% for localized, 48.2% for regional, and 17.9% for distant stage. From 2002 to 2006, a significant improvement (4.7 percent units) in overall age-adjusted five-year RS was seen. The improvement was most pronounced for age groups 55-64 years (from 54.2 to 65.6%) and 65-74 years (from 50.0 to 58.1%). Conclusion. In this first comprehensive population-based study from Germany, prognosis of cervical cancer strongly varied by age and stage. Prognosis continued to improve, in particular in age range 55-74 years, in the five-year period assessed.     

以大型单中心医院登记为基础的1.37万例结直肠癌手术患者生存报告

背景与目的:基于医院登记为基础的结直肠癌手术患者的随访资料,分析其1、3和5年总生存率(overall survival,OS)与无病生存率(disease-free survival,DFS),为了解中国结直肠癌患者长期生存情况提供真实世界研究证据。方法:研究纳入2008年1月1日-2017年12月31日在复旦大学附属肿瘤医院接受手术治疗的结直肠癌患者共13 721例,通过查阅患者复诊病史、电话随访和死因数据链接等方式收集患者的生存随访资料,随访统计时间截至2019年11月30日。采用Kaplan-Meier法估计患者1、3和5年OS和DFS,根据年龄组、性别、治疗时期、肿瘤分期以及病理学特征、治疗方式各亚组分别描述。结果:结直肠癌手术患者经中位54.03个月随访后,5年OS和0~Ⅲ期患者5年DFS分别为73.87%和72.25%。0~Ⅰ、Ⅱ、Ⅲ和Ⅳ期结直肠癌手术患者5年OS分别为91.92%、87.15%、70.49%和27.70%,45岁以下年龄组患者5年OS为74.93%,差于45~64岁和65~74岁年龄组。不同组织学类型、分化程度、壁外血管侵犯、神经侵犯、环切缘情况患者的生存差异显著。结论:首次报告中国国内单中心超万人结直肠癌患者的5年长期生存结果,44岁及以下青年结直肠癌患者生存率较低,肿瘤分期是影响结直肠癌患者生存的重要可改变因素,应加强早诊早治,进一步提升患者生存率。     

Five year survival of women with breast cancer in Ardabil, north-west of Iran

Breast cancer is the most common cancer in women, and the major cause of cancer deaths in women 20-59 years old. The present retrospective study was undertaken to examine survival in all newly diagnosed breast cancer in Iran. One hundred and sixty-one breast cancer registered patients in 2003 were included in the study and followed up for 5-years from cancer diagnosis. Data were analyzed using life tables and Kaplan Meier for estimating relative survival rates and Cox's proportional hazard model to investigate the interaction between variables. The mean age of the patients at diagnosis was 45.5 (SD=12.3), ranging from 19 to 86 years. Of all patients 90 (56%) were alive and 71 (44%) were dead after five years. Using life table analysis, the overall relative 5-year survival rate was found to be 51% (SE=0.05). Using Cox regression model analysis variables such as age, surgery, location and drug therapy significantly influenced survival. According to the results, the overall 5-year survival rate in Ardebil province was lower than other places of Iran and most countries in the world and needs to be improved. Also, results showed that breast cancer screening programs, awareness regarding early detection of breast cancer and education of health care providers are necessary.     

Survival from breast cancer among South Asian and non-South Asian women resident in South East England

Ethnic differences in breast cancer survival have been observed in the USA but have not been examined in Britain. We aimed to investigate such differences between South Asian (i.e. those with family roots in the Indian subcontinent) and non-South Asian (essentially British-native) women in England. Primary breast cancer cases incident in 1986 -1993 and resident in South East England were ascertained through the Thames Cancer and Registry and followed up to the end of 1997. Cases of South Asian ethnicity were identified on the basis of their names by using a previously validated computer algorithm. A total of 1037 South Asian and 50 201 non-South Asian breast cancer cases were included in the analysis; 30% of the South Asian (n=312) and 44% (n=22 201) of the non-South Asian cases died during follow-up. South Asian cases had a higher relative survival than non-South Asians throughout the follow-up period. The 10-year relative survival rates were 72.6% (95% confidence interval: 69.0, 75.9%) and 65.2% (64.5, 65.8%) for South Asians and non-South Asians, respectively. The excess mortality rates experienced by South Asians were 82% (72, 94%) of those experienced by non-South Asians (P=0.004). The magnitude of this effect was slightly reduced with adjustment for differences in age at diagnosis, but was strengthened with further adjustment for differences in stage at presentation and socioeconomic deprivation (excess mortality rates in South Asians relative to non-South Asians=72% (63, 82%), P&<0.001). These findings indicate that the higher survival from breast cancer in the first 10 years after diagnosis among South Asian was not due to differences in age at diagnosis, socioeconomic deprivation or disease stage at presentation.     

Do younger female breast cancer patients have a poorer prognosis? Results from a population‐based survival analysis

Younger women who develop breast cancer are hypothesized to have poorer survival rates than women who develop it at a later stage in life. Several studies have suggested that differences in biologic characteristics of breast cancer in younger (premenopausal) and older (postmenopausal) women may account for the prognostic variation. This population-based cohort study reports on survival rates of breast cancer in Singapore and examines the hypothesis that younger breast cancer patients have a poorer prognosis. A total of 6,397 breast cancer patients diagnosed from 1968 to 1992 were identified from the population-based cancer registry and followed up through 1997. Outcome measures were relative survival rates (RSRs) calculated using Hakulinen's method and excess hazards ratios (HRs) derived from a regression model based on relative survival. The 2-, 5- and 10-year RSRs were worse among those aged > 75 (65%, 48% and 39%, respectively). The best survival rates were seen among those aged 40-44 (84%, 67% and 56%). Patients younger than 35 years faired reasonably well (79%, 60% and 50%). When the data were stratified according to clinical stage and calendar year, the highest risk of excess deaths was found in women > or = 75 years old. In patients with localized cancer and/or regional metastases, those in the 35-39 age group had the lowest excess risk. In patients with distant metastases, those younger than 35 years of age had the lowest excess risk of death. At the population level, younger women (< 45 years) with breast cancer in Singapore have higher relative survival rates.     

Retrospective analysis of locally advanced noninflammatory breast cancer from Chennai, South India, 1990-1999

PURPOSE: This was a retrospective observational study to elicit the outcome of the therapeutic strategy of concurrent neoadjuvant chemoradiotherapy protocol for locally advanced breast cancer. METHODS AND MATERIALS: A large series of 1,117 consecutive cases of locally advanced breast cancer treated at the Cancer Institute (WIA), in Chennai, South India, between 1990 and 1999 and followed through 2004 formed the basis for this study. Disease-free survival was the main outcome, and nodal and tumor downstaging were the intermediate outcome measures studied. RESULTS: Primary tumor downstaging was observed in 45% and nodal downstaging in 57.5%. The disease-free survival rate of nodal downstaged patients at 5, 10, and 15 years was 75%, 65%, and 58%, respectively. The corresponding rates for pre- and postoperative node-negative patients were 70%, 60%, and 59%. The best survival was seen among those who were tumor and node negative postoperatively. Nodal downstaging halved the risk of disease recurrence and death compared with node positivity, irrespective of tumor sterility. CONCLUSIONS: A randomized trial using cyclophosphamide, methotrexate, and 5-fluorouracil vs. an anthracycline-based regimen in the setting of concurrent chemoradiotherapy appears indicated. Additional preoperative chemotherapy to maximize nodal and tumor downstaging should be investigated. A change in postoperative chemotherapy according to nodal status could also be explored.     

Rising incidence of breast cancer: relationship to stage and receptor status

We used the population-based tumor registry of Kaiser Permanente in the United States (Portland, OR) to analyze breast cancer incidence from 1960 to 1985. Overall, incidence rose 45% during this period. The largest increases occurred in women 60 years of age or older (74%) and in those 45-59 (36%). The rate in women aged 20-44 has remained essentially unchanged. Localized and regional disease showed similar increases. Review of medical records revealed that only a small portion of this increase was likely to result from increased screening activities. From the increased availability of receptor assays in a large proportion of cases since the mid-1970s, we observed that incidence of estrogen receptor-negative cancers rose 22%-27% between the mid-1970s and the mid-1980s. In contrast, incidence of estrogen receptor-positive tumors increased an average of 131% in the same period, perhaps implicating hormonal factors in the rising incidence of breast cancer.     

Cancer patient survival in Sweden at the beginning of the third millennium – predictions using period analysis

Estimates of cancer patient survival made using traditional, cohort-based, methods can be heavily influenced by the survival experience of patients diagnosed many years in the past and may not be particularly relevant to recently diagnosed patients. Period-based survival analysis has been shown to provide better predictions of survival for recently diagnosed patients and earlier detection of temporal trends in patient survival than cohort analysis. We aim to provide predictions of the long-term survival of recently diagnosed cancer patients using period analysis. The period estimates are compared with the latest available cohort-based estimates. Our results, based on period analysis for the years 2000–2002, suggest an improvement in survival for many forms of cancer during recent years. For all sites combined the 5-, 10-, 15-, and 20-year relative survival ratios were 62, 53, 48, and 47 for males and 67, 62, 60, and 59, for females. These estimates were 3–14 units higher than those obtained using the latest available cohorts with the respective lengths of follow-up. The interval-specific relative survival stabilised for males at 97 after 8years of follow-up and for females at 98 after 7years for both period and cohort analyses.     

Long-term survival in node-positive breast cancer treated by locoregional therapy alone.

To investigate the long-term survival rate of node-positive (pN+) breast cancer treated by locoregional therapy alone, we made an attempt to identify all such patients followed up for at least 15 years after treatment in a defined geographical area (city of Turku, Southwestern Finland) and time period (1945-79) using the files of the local hospitals and the Finnish Cancer Registry. The clinical and autopsy records and histological slides of 1172 women diagnosed with breast cancer in the city were reviewed. From this cohort we identified 339 women with unilateral node-positive breast cancer treated with locoregional therapy without systemic adjuvant therapy. The relative survival rate of the cohort compared with the general female population matched for age and year of follow-up was calculated. The 15- and 30-year survival rates corrected for known intercurrent deaths were 26% (95% CI, 21-31%) and 21% (16-26%) respectively, and the relative survival rates 23% and 21% respectively. None of the patients with pN2 disease survived for 15 years, whereas the 30-year corrected survival rate in pN1 disease was 24% (18-30%). Women with pT1N1M0 cancer had as high as 59% (43-75%) 15-year survival rate corrected for intercurrent deaths. A trend for improving survival was found by the decade of diagnosis. The results indicate that a considerable proportion of women with pN1 breast carcinoma treated with locoregional therapy alone become 30-year survivors and are probably cured. Adequate locoregional treatment is mandatory in the care of node-positive breast cancer.     

Outcomes in patients with primary breast cancer and a subsequent diagnosis of endometrial cancer : comparison of cohorts treated with and without tamoxifen

BACKGROUND: The study compared tumor characteristics and survival in women with breast cancer who subsequently developed endometrial cancer with or without a history of tamoxifen use. METHODS: The British Columbia Cancer Agency registry identified 163 women diagnosed with breast cancer between 1989-1999 who received a subsequent diagnosis of endometrial cancer. Of these, 55% (n = 90) had a history of tamoxifen use. Outcomes analyzed were breast cancer-specific survival (BCSS), endometrial cancer-specific survival (ECSS), and overall survival (OS). RESULTS: Median follow-up was 9.4 years. Distributions of age, menopausal status, body mass index, and comorbidities were similar in the tamoxifen-treated and nontamoxifen cohorts. Proportions of aggressive endometrial cancer subtypes including papillary serous, clear cell, and mixed mullerian tumors were higher in the tamoxifen cohort (28% vs14%, P = .03). Distributions of endometrial cancer grade and stage were similar in the 2 groups (P > .05). Hysterectomy and/or oophorectomy were the primary treatments for endometrial cancer in 99% of patients, with comparable pelvic control rates in the tamoxifen and nontamoxifen groups. At 10 years, patients in the tamoxifen group experienced lower BCSS compared with the nontamoxifen group (89% vs 97%, P = .02). No significant differences in ECSS and OS were observed between the 2 groups (ECSS 82% and 82%, P = .85; and OS 69% v. 66%, P = .85). CONCLUSIONS: In patients with breast cancer who developed a subsequent endometrial cancer, tamoxifen-treated patients had higher proportions of aggressive endometrial cancer subtypes, but almost all cases were amenable to surgery, thus resulting in similar endometrial cancer control and survival when compared with nontamoxifen treated patients.