Abstract

Background

Older patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival.

Methods

Population-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated.

Results

In total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6% (Netherlands) to 84.6% (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30–6.72, P < .001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium.

Conclusions

There is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.

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Acknowledgements

We thank all the members of the EURECCA Breast Cancer group for data collection and preparation of the data sets. Furthermore, we thank Michel P. Villerius for sharing his knowledge on high performance computing and for his help with the implementation of our planned analysis.

Authors Contributon

MD and EB contributed to study design, data preparation, data analysis and interpretation, prepared the first draft of the report, contributed to subsequent versions and the final report. JP, GL, PB and LW contributed to data interpretation, reviewed the first draft of the report, subsequent versions and the final version. MK initiated the study, contributed to data preparation and interpretation, reviewed to the first draft of the report, subsequent versions and the final version. DH contributed to data preparation and interpretation, reviewed to the first draft of the report, subsequent versions and the final version. PW, EE, SS, JB, MT, AK, JCF, TN, WZ and AG contributed to data collection, data interpretation, reviewed the first draft of the report, subsequent drafts and the final report. RA and CvdV initiated the study, contributed to study design, data interpretation, reviewed the first draft of the report, subsequent drafts and the final report. Contributions are guaranteed by the corresponding author (CvdV).

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Affiliations

  1. Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands

    • Marloes G. M. Derks
    • , Esther Bastiaannet
    • , Mandy Kiderlen
    • , Denise E. Hilling
    • , Petra G. Boelens
    • , Gerrit-Jan Liefers
    •  & Cornelis J. H. van de Velde
  2. Department of Gerontology & Geriatrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands

    • Esther Bastiaannet
  3. National Cancer Registry of Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, T12 CDF7, Ireland

    • Paul M. Walsh
  4. Belgian Cancer Registry, Koningsstraat 215, Brussels, 1210, Belgium

    • Elizabeth van Eycken
  5. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, Utrecht, 3511 DT, The Netherlands

    • Sabine Siesling
  6. Public Health England, 5 St Philip’s Place, Birmingham, B3 2PW, UK

    • John Broggio
  7. Department of Oncology and Metabolism, University of Sheffield, Western Bank, Sheffield, S10 2TN, UK

    • Lynda Wyld
  8. Greater Poland Cancer Registry, Greater Poland Cancer Center, Garbary 15, Poznań, 60-101, Poland

    • Maciej Trojanowski
  9. Department of Head and Neck Cancer Surgery, Department of Surgical Oncology, Medical University of Lodz, Kościuszki 4, Łódź, 90-419, Poland

    • Agnieszka Kolacinska
  10. Department of Radiotherapy, Medical University of Lodz, Kościuszki 4, Łódź, 90-419, Poland

    • Justyna Chalubinska-Fendler
  11. Portuguese Oncology Institute of Porto, R. Dr. António Bernardino de Almeida 62, Porto, 4200-162, Portugal

    • Ana Filipa Gonçalves
  12. Department of Surgical Oncology, Ludwik Rydygier’s Collegium Medicum, Jagiellońska 13-15, Bydgoszcz, 85-067, Poland

    • Tomasz Nowikiewicz
    •  & Wojciech Zegarski
  13. Department of Surgery, St Helens Teaching Hospital, University of Liverpool, Marshalls Cross Rd, Saint Helens, St Helens, WA9 3DA, UK

    • Riccardo A. Audisio
  14. Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands

    • Johanneke E. A. Portielje

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Consortia

  1. on behalf of the EURECCA Breast Cancer Group

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Ethical approval

    Cancer registries provided anonymised patient data. Therefore, informed consent from patients or ethical approval were not required for this study.

    Availability of data

    Patient level data are available upon request from the separate participating cancer registries. Access to the full data set will be provided if each participating cancer registry gives permission for data sharing. Statistical code is available upon request with the corresponding author.

    Funding

    This work was supported by the European Society of Surgical Oncology (ESSO). The funding source had no role in the study design, data collection, analysis, interpretation of the data, writing of the manuscript, or the decision to publish. Researchers were independent from the funding source.

    Note

    This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).

    Corresponding author

    Correspondence to Cornelis J. H. van de Velde.

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    DOI

    https://doi.org/10.1038/s41416-018-0090-1