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Comorbidities,age and period of diagnosis influence treatment and outcomes in early breast cancer |
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| Authors: | Pamela Minicozzi Liesbet Van Eycken Florence Molinie Kaire Innos Marcela Guevara Rafael Marcos-Gragera Clara Castro Elisabetta Rapiti Alexander Katalinic Ana Torrella Tina Žagar Magdalena Bielska-Lasota Paolo Giorgi Rossi Nerea Larrañaga Joana Bastos Maria José Sánchez Milena Sant the European HR Working Group on breast cancer |
| Institution: | 1. Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy;2. Research Department, Belgian Cancer Registry, Brussels, Belgium;3. Loire-Atlantique/Vendée Cancer Registry, Nantes, France
SIRIC-ILIAD, CHU Nantes, Nantes, France;4. Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia;5. Navarra Cancer Registry, Public Health Institute of Navarra, IDISNA, Pamplona, Spain Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain;6. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain Epidemiology Unit and Girona Cancer Registry, Department of Health, Catalan Institute of Oncology (ICO), Girona, Spain;7. Department of Epidemiology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal;8. Geneva Cancer Registry, Global Health Institute, University of Geneva, Geneva, Switzerland;9. University of Lübeck, Institute for Social Medicine and Epidemiology, Lübeck, Germany;10. Castellón Cancer Registry, Epidemiology Unit, Public Health Department, Castellón, Spain;11. Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia;12. Department of Health Promotion and Prevention of Chronic Diseases, National Institute of Public Health (NIH), Warsaw, Poland;13. Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy;14. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain Public Health Department of Gipuzkoa, Donostia, Spain;15. EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal Portuguese Institute of Oncology Francisco Gentil (IPO Coimbra), Coimbra, Portugal;16. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain Andalusian School of Public Health, Granada Cancer Registry, Granada, Spain Biomedical Research Institute of Granada (ibs. Granada), Granada, Spain |
| Abstract: | Survival for breast cancer (BC) is lower in eastern than northern/central Europe, and in older than younger women. We analysed how comorbidities at diagnosis affected whether selected standard treatments (STs) were given, across Europe and over time, also assessing consequences for survival/relapse. We analysed 7581 stage I/IIA cases diagnosed in 9 European countries in 2009–2013, and 4 STs: surgery; breast-conserving surgery plus radiotherapy (BCS + RT); reconstruction after mastectomy; and prompt treatment (≤6 weeks after diagnosis). Covariate-adjusted models estimated odds of receiving STs and risks of death/relapse, according to comorbidities. Pearson's R assessed correlations between odds and risks. The z-test assessed the significance of time-trends. Most women received surgery: 72% BCS; 24% mastectomy. Mastectomied patients were older with more comorbidities than BCS patients (p < 0.001). Women given breast reconstruction (25% of mastectomies) were younger with fewer comorbidities than those without reconstruction (p < 0.001). Women treated promptly (45%) were younger than those treated later (p = 0.001), and more often without comorbidities (p < 0.001). Receiving surgery/BCS + RT correlated strongly (R = −0.9), but prompt treatment weakly (R = −0.01/−0.02), with reduced death/relapse risks. The proportion receiving BCS + RT increased significantly (p < 0.001) with time in most countries. This appears to be the first analysis of the influence of comorbidities on receiving STs, and of consequences for outcomes. Increase in BCS + RT with time is encouraging. Although women without comorbidities usually received STs, elderly patients often received non-standard less prompt treatments, irrespective of comorbidities, with increased risk of mortality/relapse. All women, particularly the elderly, should receive ST wherever possible to maximise the benefits of modern evidence-based treatments. |
| Keywords: | early breast cancer comorbidities standard treatment outcomes population study |