Variation in 'standard care' for breast cancer across Europe: a EUROCARE-3 high resolution study

Autor: Claudia Allemani, Pascale Grosclaude, Isabel Garau, Giovanna Tagliabue, Adele Traina, Hans H. Storm, Ana Torrella-Ramos, Arlette Danzon, Milena Sant, G. Hedelin, Laufey Tryggvadottir, Karin Peignaux, Kaija Holli, Massimo Federico, Magdalena Bielska-Lasota, Maja Primic-Zakelj, IsabeI Izarzugaza, Marina Vercelli, Eva Ardanaz, Tiiu Aareleid, Marc Colonna, I Plesko, Carmen Martinez-Garcia, Jadwiga Rachtan, Rosario Tumino, Emanuele Crocetti, Adri C. Voogd
Přispěvatelé: Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Epidemiology and Biostatistics, National Institute for Health Development and Estonian Cancer Registry, CIBER Epidemiologia y Salud Publica, CIBER de Epidemiología y Salud Pública (CIBERESP), Public Health Institute of Navarra, FRANCIM, Réseau des registres français du cancer, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Registre des cancers du Tarn, Epidémiologie et analyses en santé publique :risques, maladies chroniques et handicaps, Université Paul Sabatier - Toulouse 3 ( UPS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Registre des cancers du Bas-Rhin, CRLCC Paul Strauss, National Cancer Registry of Slovakia, Cancer Research Institut of Slovak Academy of Sciences, Cracow Cancer Registry, M.Sklodowsk-Curie Memorial Cancer Institute, Varese Cancer Registry, Cancer Registry and Histopathology Unit, 'Civile M.P.Arezzo' hospital, Liguria Cancer Registry, Descriptive Epidemiology Unit, National Cancer Research Institute, Recherche en Epidémiologie et Prévention, Tarn Cancer Registry, Department of Preventive and Predictive Medicine, Unit of Etiological Epidemiology and Prevention, Istituto Nazionale per lo Studio e la Cura dei Tumori, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Civile - M.P.Arezzo Hospital, Epidemiologie, RS: CAPHRI School for Public Health and Primary Care, RS: GROW - School for Oncology and Reproduction
Jazyk: angličtina
Rok vydání: 2010
Předmět:
Zdroj: European Journal of Cancer
European Journal of Cancer, Elsevier, 2010, 46 (9), pp.1528-1536. 〈10.1016/j.ejca.2010.02.016〉
European Journal of Cancer, Elsevier, 2010, 46 (9), pp.1528-1536. ⟨10.1016/j.ejca.2010.02.016⟩
European Journal of Cancer, 46(9), 1528-1536. ELSEVIER SCI LTD
ISSN: 0959-8049
DOI: 10.1016/j.ejca.2010.02.016〉
Popis: International audience; On a population-based sample of 13,500 European breast cancer patients mostly diagnosed in 1996-1998 and archived by 26 cancer registries, we used logistic regression to estimate odds of conservative surgery plus radiotherapy (BCS+RT) versus other surgery, in T1N0M0 cases by country, adjusted for age and tumour size. We also examined: BCS+RT in relation to total national expenditure on health (TNEH); chemotherapy use in N+ patients; tamoxifen use in oestrogen-positive patients; and whether 10 nodes were examined in lymphadenectomies. Stage, diagnostic examinations and treatments were obtained from clinical records. T1N0M0 cases were 33.0% of the total. 55.0% of T1N0M0 received BCS+RT, range 9.0% (Estonia) to 78.0% (France). Compared to France, odds of BCS+RT were lower in all other countries, even after adjusting for covariates. Women of 70-99 years had 67% lower odds of BCS+RT than women of 15-39 years. BCS+RT was 20% in low TNEH, 58% in medium TNEH, and 64% in high TNEH countries. Chemotherapy was given to 63.0% of N+ and 90.7% of premenopausal N+ (15-49 years), with marked variation by country, mainly in post-menopause (50-99 years). Hormonal therapy was given to 55.5% of oestrogen-positive cases, 44.6% at 15-49 years and 58.8% at 50-99 years; with marked variation across countries especially in premenopause. The variation in breast cancer care across Europe prior to the development of European guidelines was striking; older women received BCS+RT much less than younger women; and adherence to 'standard care' varied even among countries with medium/high TNEH, suggesting sub-optimal resource allocation.
Databáze: OpenAIRE
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