Survival of breast cancer patients in German-Danish border regions – A registry-based cohort study |
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| Institution: | 1. Institute for Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany;2. Danish Cancer Society, Strandboulevarden 49, 2100, København, Denmark;1. Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Paediatric Oncology and Haematology, Germany;2. Charité-Universistätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Germany;3. Charité-Univesristätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology (iBiKE), Germany;4. St. Anna Kinderspital Vienna, Austria;5. University Hospital Hradec Králové, Czech Republic;6. University Hospital Ostrava, Czech Republic;7. University Hospital Brno, Czech Republic;8. Medical University Bialystok, Poland;9. University Hospital Motol, Prague, Czech Republic;10. Medical University Graz, Austria;11. University of Lucerne, Department of Health Sciences and Medicine, Switzerland;12. Medical University Wroclaw, Poland;13. Kepler Universitätsklinikum GmbH, Linz, Austria;14. Eastern Switzerland University of Applied Sciences, Department of Health Sciences, Institute of Applied Nursing Science, St. Gallen, Switzerland;15. Berlin Institute of Health (BIH), Berlin, Germany;1. Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA;2. Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA;3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA;4. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA;5. Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA;1. Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda;2. Harvard Medical School, Boston, MA, United States;3. Moi University, Eldoret, Kenya;4. Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;5. University of California, San Francisco, CA, United States;6. Masaka Regional Referral Hospital, Masaka, Uganda;7. Mbarara Regional Referral Hospital, Mbarara, Uganda;8. Indiana University, Indianapolis, IN, United States;1. Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;2. Department of Biostatistics and Epidemiology, Kermanshah University of Medical Sciences, Kermanshah, Iran;3. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;4. Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden;5. Centrum for Epidemiology and Community Medicine, Healthcare Provision, Stockholm County, Sweden;1. Regional Cancer Center, Trivandrum, Kerala, India;2. Natural Background Radiation Cancer Registry, Karunagappally, Kerala, India;3. Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan;1. Laboratory of Cancer Epidemiology, National Cancer Institute, P. Baublio 3B, LT-08406, Vilnius, Lithuania;2. Institute of Health Sciences, Faculty of Medicine, Vilnius University, M.K. Ciurlionio. 21, LT-03101, Vilnius, Lithuania;3. External Beam Radiotherapy Department, National Cancer Institute, Santariskių 1, LT-08660, Vilnius, Lithuania;4. Environmental and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France |
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| Abstract: | Background and AimDenmark reports slightly lower breast cancer survival before 2010 than its neighbouring country Germany. Previous research is limited by lacking stage and treatment information. This study aims to investigate differences in breast cancer survival between the bordering regions Schleswig-Holstein (Germany), Southern Denmark and Zealand (Denmark) using registry data including stage and treatment information.MethodInvasive female breast cancer cases diagnosed during 2004−2013 with follow up through 31st December 2014 were extracted from cancer registries. Cases notified by death certificates only and those aged 90+ years were excluded. Kaplan-Meier curves and log-rank tests were computed. Cox regression analysis was conducted with adjustment for year of diagnosis, age, stage, and treatment.ResultsThe analytical sample included 42,966 cases. Kaplan-Meier curves and log-rank tests show significant survival differences between the regions. The Cox regression model adjusted for year of diagnosis and age shows significantly worse overall survival of breast cancer patients in both Danish regions compared to Schleswig-Holstein with hazard ratios (HR) of 1.09 (95 % CI: 1.04; 1.15) for patients from Southern Denmark (SD) and 1.25 (95 % CI: 1.18; 1.32) for residents of Zealand (ZL). This effect diminished after adjustment for stage and treatment (HR: 1.05 (SD), 1.09 (ZL) 95 % CI: 0.99; 1.10 (SD), 1.03; 1.15 (ZL)).ConclusionSurvival differences can be explained by differing stage distribution and treatment administration, which formerly were more favourable in Schleswig-Holstein. The survival gap will probably close due to Denmark’s national screening program and increased use of adjuvant cancer therapy. |
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| Keywords: | Breast neoplasms Radiotherapy Chemotherapy Surgery Neoplasm staging Proportional hazards models |
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