Trends of population-based breast cancer survival in Germany and the US: Decreasing discrepancies, but persistent survival gap of elderly patients in Germany

BMC Cancer

Bernd Holleczek¹  Hermann Brenner² 

[1] Saarland Cancer Registry, Präsident Baltz-Straße 5, 66119 Saarbrücken, Germany

[2] Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany

关键词: United States;    Germany;    Trends;    Population-based;    Survival;    Female breast cancer;   

Others  :  1080290
DOI  :  10.1186/1471-2407-12-317

 received in 2012-06-17, accepted in 2012-07-18,  发布年份 2012

【 摘 要 】

Background

Studies have revealed both higher cancer survival in the US than in Germany and substantial improvement of cancer survival in the past in these countries. This population-based study aims at comparing most recent 5-year relative survival of breast cancer patients and preceding trends in both countries.

Methods

Women with a first invasive breast cancer diagnosed and followed up between 1988 and 2008 from Germany and the US (utilizing data from the Saarland Cancer Registry and the Surveillance, Epidemiology, and End Results Program, respectively) were included. Period analysis was used to derive most up-to-date 5-year relative survival and preceding survival trends according to age and stage.

Results

Since 1993, age standardized relative survival has steadily improved in Germany and the US to 83% and 88%, respectively. In the period 2005–08, relative survival of localized cancer was above 97% in both countries, and 79% and 83% for locally/regionally spread breast cancer, respectively. Prognosis of metastasized disease has remained very poor overall, with improvement essentially being restricted to younger patients. The proportion of patients diagnosed with localized breast cancer was consistently higher in the US. If adjusted for stage, the differences in relative survival between both countries diminished over time and eventually disappeared.

Conclusions

Similar survival is now observed in both countries for patients below the age of 70 years, but in Germany survival is still much lower for elderly patients. The observed trends point to treatment advances as a major cause for improved survival. However, substantial differences in mammography usage existed between both countries and might probably also account for the observed differences (to a lesser extent, also differences in health care systems, and delivery of cancer care). Encouraging, survival of breast cancer patients has improved in Germany to a much greater extent than in the US, albeit the persisting survival gap for elderly patients in Germany requires particular attention by researchers, public health authorities, and clinicians.

【 授权许可】

   
2012 Holleczek and Brenner; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Botha JL, Bray F, Sankila R, Parkin DM: Breast cancer incidence and mortality trends in 16 European countries. Eur J Cancer 2003, 39:1718-1729.
• [2]Autier P, Boniol M, La Vecchia C, Vatten L, Gavin A, Hery C, Heanue M: Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database. BMJ 2010, 341:c3620.
• [3]Jemal A, Center MM, DeSantis C, Ward EM: Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010, 19:1893-1907.
• [4]Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, Mandelblatt JS, Yakovlev AY, Habbema JD, Feuer EJ: Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005, 353:1784-1792.
• [5]Elmore JG, Armstrong K, Lehman CD, Fletcher SW: Screening for breast cancer. JAMA 2005, 293:1245-1256.
• [6]Verdecchia A, Guzzinati S, Francisci S, De Angelis R, Bray F, Allemani C, Tavilla A, Santaquilani M, Sant M: Survival trends in European cancer patients diagnosed from 1988 to 1999. Eur J Cancer 2009, 45:1042-1066.
• [7]Gondos A, Bray F, Hakulinen T, Brenner H: Trends in cancer survival in 11 European populations from 1990 to 2009: a model-based analysis. Ann Oncol 2009, 20:564-573.
• [8]SEER Cancer Statistics Review, 1975–2008 (based on November 2010 SEER data submission, posted to the SEER web site). [http://seer.cancer.gov/csr/1975_2008/index.html webcite]
• [9]Rosso S, Gondos A, Zanetti R, Bray F, Zakelj M, Zagar T, Smailyte G, Ponti A, Brewster DH, Voogd AC, et al.: Up-to-date estimates of breast cancer survival for the years 2000–2004 in 11 European countries: the role of screening and a comparison with data from the United States. Eur J Cancer 2010, 46:3351-3357.
• [10]Gondos A, Arndt V, Holleczek B, Stegmaier C, Ziegler H, Brenner H: Cancer survival in Germany and the United States at the beginning of the 21st century: an up-to-date comparison by period analysis. Int J Cancer 2007, 121:395-400.
• [11]Sant M, Allemani C, Berrino F, Coleman MP, Aareleid T, Chaplain G, Coebergh JW, Colonna M, Crosignani P, Danzon A, et al.: Breast carcinoma survival in Europe and the United States. Cancer 2004, 100:715-722.
• [12]Coleman MP, Quaresma M, Berrino F, Lutz JM, De Angelis R, Capocaccia R, Baili P, Rachet B, Gatta G, Hakulinen T, et al.: Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 2008, 9:730-756.
• [13]Holleczek B, Arndt V, Stegmaier C, Brenner H: Trends in breast cancer survival in Germany from 1976 to 2008-A period analysis by age and stage. Cancer Epidemiol 2011, 35:399-406.
• [14]Brenner H, Stegmaier C, Ziegler H: Estimating completeness of cancer registration: an empirical evaluation of the two source capture-recapture approach in Germany. J Epidemiol Community Health 1995, 49:426-430.
• [15]Robert Koch Institute, Association of Population-based Cancer Registries in Germany (Ed): Cancer in Germany 2003–2004. Incidence and Trends. Berlin: Robert Koch Institute; 2008.
• [16]Surveillance, Epidemiology, and End Results (SEER) Program: Research Data 1973–2008 (released April 2011, based on the November 2010 submission). Bethesda MD: National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch; 2011.
• [17]Hermanek P, Sobin LH (Eds): TNM Classification of Malignant Tumours. 4th edition. Berlin: Springer; 1987.
• [18]Sobin LH, Wittekind C (Eds): UICC TNM Classification of Malignant Tumours. 5th edition. New York: Wiley-Liss; 1997.
• [19]Sobin LH, Wittekind C (Eds): TNM Classification of Malignant Tumours. 6th edition. New York: Wiley-Liss; 2002.
• [20]Klein RJ, Schoenborn CA: Age adjustment using the 2000 projected U.S. population. Healthy People 2010. Stat Notes 2001, 20:1-10.
• [21]Ederer F, Axtell LM, Cutler SJ: The relative survival rate: a statistical methodology. Natl Cancer Inst Monogr 1961, 6:101-121.
• [22]Ederer F, Heise H: Instructions to IBM 650 programmers in processing survival computations. Bethesda (MD): National Cancer Institute; 1959.
• [23]Surveillance, Epidemiology, and End Results (SEER) Program: SEER*Stat Database: Mortality - All COD, Aggregated With State, Total U.S. (1969–2008). Underlying mortality data provided by NCHS. Bethesda MD: National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch; 2011. (http://www.cdc.gov/nchs webcite)
• [24]Surveillance, Epidemiology, and End Results (SEER) Program: SEER*Stat Database: Populations - Total U.S. (1969–2009). Linked to country attributes - Total U.S. (1969–2009)). Bethesda, MD: National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch; 2011.
• [25]Elandt-Johnson R, Johnson N: Survival Models and Data Analysis (Wiley Series in Probability and Mathematical Statistics). Indianapolis: John Wiley & Sons; 1980.
• [26]Baili P, Micheli A, Montanari A, Capocaccia R: Comparison of Four Methods for Estimating Complete Life Tables from Abridged Life Tables Using Mortality Data Supplied to EUROCARE-3. Math Popul Stud 2005, 12:183-198.
• [27]National Center for Health Statistics: U.S. decennial life tables for 1989–91, vol 1, no. 2, methodology of the national and State life tables. Maryland: Hyattsville; 1998.
• [28]Brenner H, Gefeller O, Hakulinen T: Period analysis for 'up-to-date' cancer survival data: theory, empirical evaluation, computational realisation and applications. Eur J Cancer 2004, 40:326-335.
• [29]Talback M, Stenbeck M, Rosen M: Up-to-date long-term survival of cancer patients: an evaluation of period analysis on Swedish Cancer Registry data. Eur J Cancer 2004, 40:1361-1372.
• [30]Brenner H, Hakulinen T: Up-to-date long-term survival curves of patients with cancer by period analysis. J Clin Oncol 2002, 20:826-832.
• [31]Brenner H, Soderman B, Hakulinen T: Use of period analysis for providing more up-to-date estimates of long-term survival rates: empirical evaluation among 370,000 cancer patients in Finland. Int J Epidemiol 2002, 31:456-462.
• [32]Brenner H, Hakulinen T: Up-to-date and precise estimates of cancer patient survival: model-based period analysis. Am J Epidemiol 2006, 164:689-696.
• [33]Corazziari I, Quinn M, Capocaccia R: Standard cancer patient population for age standardising survival ratios. Eur J Cancer 2004, 40:2307-2316.
• [34]Greenwood M: A report on the natural duration of cancer. HM Stationery Office: Reports on Public Health and Medical Subjects. London; 1926.
• [35]Holleczek B, Gondos A, Brenner H: periodR - an R package to calculate long-term cancer survival estimates using period analysis. Methods Inf Med 2009, 48:123-128.
• [36]European Community Health Indicators (ECHI). [http://www.gbe-bund.de/gbe10/abrechnung.prc_abr_test_logon?p_uid=gast&p_aid=38176193&p_sprache=E&p_knoten=TR80000 webcite]
• [37]DeNavas-Walt C, Proctor BD, Smith JC: Current Population Reports, P60-235, Income, Poverty, and Health InsuranceCoverage in the United States: 2007. Washington, DC: U.S. Census Bureau; 2008.
• [38]Anderson GF, Hussey PS, Frogner BK, Waters HR: Health spending in the United States and the rest of the industrialized world. Health Aff (Millwood) 2005, 24:903-914.
• [39]Shapiro S, Coleman EA, Broeders M, Codd M, de Koning H, Fracheboud J, Moss S, Paci E, Stachenko S, Ballard-Barbash R: Breast cancer screening programmes in 22 countries: current policies, administration and guidelines. International Breast Cancer Screening Network (IBSN) and the European Network of Pilot Projects for Breast Cancer Screening. Int J Epidemiol 1998, 27:735-742.
• [40]Swan J, Breen N, Coates RJ, Rimer BK, Lee NC: Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer 2003, 97:1528-1540.
• [41]Use of Mammography Among Women 40 Years of Age and over. [http://.cdc.gov/nchs/health_policy/mammography.htm webcite]
• [42]Becker N: Epidemiological aspects of cancer screening in Germany. J Cancer Res Clin Oncol 2003, 129:691-702.
• [43]Low M, Stegmaier C, Ziegler H, Rothenbacher D, Brenner H: Epidemiological investigations of the chances of preventing, recognizing early and optimally treating chronic diseases in an elderly population (ESTHER study). Dtsch Med Wochenschr 2004, 129:2643-2647.
• [44]Raum E, Rothenbacher D, Low M, Stegmaier C, Ziegler H, Brenner H: Changes of cardiovascular risk factors and their implications in subsequent birth cohorts of older adults in Germany: a life course approach. Eur J Cardiovasc Prev Rehabil 2007, 14:809-814.
• [45]Malek D, Rabe P: Evaluationsbericht 2008–2009. Ergebnisse des Mammographie-Screening-Programms in Deutschland. Berlin: Kooperationsgemeinschaft Mammographie; 2012.
• [46]Dreier M, Borutta B, Toppich J, Bitzer EM, Walter U: Mammography and Cervical Cancer Screening - A Systematic Review about Women's Knowledge, Attitudes and Participation in Germany. Gesundheitswesen 2011.
• [47]Barchielli A, Federico M, De Lisi V, Bucchi L, Ferretti S, Paci E, Ponti A, Buiatti E: In situ breast cancer: incidence trend and organised screening programmes in Italy. Eur J Cancer 2005, 41:1045-1050.
• [48]Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C: Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 1996, 275:913-918.
• [49]Virnig BA, Tuttle TM, Shamliyan T, Kane RL: Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst 2010, 102:170-178.
• [50]Glass AG, Lacey JV Jr, Carreon JD, Hoover RN: Breast cancer incidence, 1980–2006: combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. J Natl Cancer Inst 2007, 99:1152-1161.
• [51]Ravdin PM, Cronin KA, Howlader N, Berg CD, Chlebowski RT, Feuer EJ, Edwards BK, Berry DA: The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 2007, 356:1670-1674.
• [52]Wishart GC, Greenberg DC, Britton PD, Chou P, Brown CH, Purushotham AD, Duffy SW: Screen-detected vs symptomatic breast cancer: is improved survival due to stage migration alone? Br J Cancer 2008, 98:1741-1744.
• [53]Janssen-Heijnen ML, Maas HA, Houterman S, Lemmens VE, Rutten HJ, Coebergh JW: Comorbidity in older surgical cancer patients: influence on patient care and outcome. Eur J Cancer 2007, 43:2179-2193.
• [54]Bouchardy C, Rapiti E, Fioretta G, Laissue P, Neyroud-Caspar I, Schafer P, Kurtz J, Sappino AP, Vlastos G: Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol 2003, 21:3580-3587.
• [55]Lavelle K, Todd C, Moran A, Howell A, Bundred N, Campbell M: Non-standard management of breast cancer increases with age in the UK: a population based cohort of women > or =65 years. Br J Cancer 2007, 96:1197-1203.
• [56]Passage KJ, McCarthy NJ: Critical review of the management of early-stage breast cancer in elderly women. Intern Med J 2007, 37:181-189.
• [57]Hancke K, Denkinger MD, Konig J, Kurzeder C, Wockel A, Herr D, Blettner M, Kreienberg R: Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study. Ann Oncol 21:748-753.
• [58]Sant M, Allemani C, Santaquilani M, Knijn A, Marchesi F, Capocaccia R: EUROCARE-4. Survival of cancer patients diagnosed in 1995–1999. Results and commentary. Eur J Cancer 2009, 45:931-991.
• [59]Vercelli M, Capocaccia R, Quaglia A, Casella C, Puppo A, Coebergh JW: Relative survival in elderly European cancer patients: evidence for health care inequalities. The EUROCARE Working Group. Crit Rev Oncol Hematol 2000, 35:161-179.
• [60]Gondos A, Holleczek B, Arndt V, Stegmaier C, Ziegler H, Brenner H: Trends in population-based cancer survival in Germany: to what extent does progress reach older patients? Ann Oncol 2007, 18:1253-1259.
• [61]Day NE: Overdiagnosis and breast cancer screening. Breast Cancer Res 2005, 7:228-229. BioMed Central Full Text
• [62]Harlan LC, Hankey BF: The surveillance, epidemiology, and end-results program database as a resource for conducting descriptive epidemiologic and clinical studies. J Clin Oncol 2003, 21:2232-2233.
• [63]Merrill RM, Dearden KA: How representative are the surveillance, epidemiology, and end results (SEER) program cancer data of the United States? Cancer Causes Control 2004, 15:1027-1034.
• [64]Wingo PA, Jamison PM, Hiatt RA, Weir HK, Gargiullo PM, Hutton M, Lee NC, Hall HI: Building the infrastructure for nationwide cancer surveillance and control–a comparison between the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) Program (United States). Cancer Causes Control 2003, 14:175-193.
• [65]Frey CM, McMillen MM, Cowan CD, Horm JW, Kessler LG: Representativeness of the surveillance, epidemiology, and end results program data: recent trends in cancer mortality rates. J Natl Cancer Inst 1992, 84:872-877.
• [66]Nattinger AB, McAuliffe TL, Schapira MM: Generalizability of the surveillance, epidemiology, and end results registry population: factors relevant to epidemiologic and health care research. J Clin Epidemiol 1997, 50:939-945.
• [67]Feinstein AR, Sosin DM, Wells CK: The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med 1985, 312:1604-1608.
• [68]Brenner H, Holleczek B: Deriving valid population-based cancer survival estimates in the presence of nonnegligible proportions of cancers notified by death certificates only. Cancer Epidemiol Biomarkers Prev 2011, 20:2480-2486.
• [69]Perme MP, Stare J, Esteve J: On estimation in relative survival. Biometrics 2012, 68:113-120.
• [70]Rothman KJ: No adjustments are needed for multiple comparisons. Epidemiology 1990, 1:43-46.
• [71]Baili P, Micheli A, De Angelis R, Weir HK, Francisci S, Santaquilani M, Hakulinen T, Quaresmas M, Coleman MP: Life tables for world-wide comparison of relative survival for cancer (CONCORD study). Tumori 2008, 94:658-668.