Breast cancer survival in the US and Europe: A CONCORD high‐resolution study
Open Access
- 20 July 2012
- journal article
- research article
- Published by Wiley in International Journal of Cancer
- Vol. 132 (5), 1170-1181
- https://doi.org/10.1002/ijc.27725
Abstract
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 15–99 years during 1996–98 in 7 US states and 12 European countries. Age‐standardized 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 (5–6%). Net survival in Northern, Western and Southern Europe (81–84%) 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 70–99 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.This publication has 35 references indexed in Scilit:
- Estimating net survival: the importance of allowing for informative censoringStatistics in Medicine, 2012
- On Estimation in Relative SurvivalBiometrics, 2011
- Variation in ‘standard care’ for breast cancer across Europe: A EUROCARE-3 high resolution studyEuropean Journal of Cancer, 2010
- EUROCARE-4. Survival of cancer patients diagnosed in 1995–1999. Results and commentaryEuropean Journal of Cancer, 2009
- Cancer survival in five continents: a worldwide population-based study (CONCORD)The Lancet Oncology, 2008
- Flexible parametric models for relative survival, with application in coronary heart diseaseStatistics in Medicine, 2007
- Reduced mortality for women with mammography-detected breast cancer in east Denmark and south SwedenEuropean Journal of Cancer, 2006
- Standard cancer patient population for age standardising survival ratiosEuropean Journal of Cancer, 2004
- Polychemotherapy for early breast cancer: an overview of the randomised trialsThe Lancet, 1998
- A new look at the statistical model identificationIEEE Transactions on Automatic Control, 1974