Variation in survival after diagnosis of breast cancer in Switzerland

Management and Outcome of Young Women (≤40 Years) with Breast Cancer in Switzerland

Background: An increase in breast cancer (BC) incidence in young women (YW) as well as disparities in BC outcomes have been reported in Switzerland. We sought to evaluate treatment and outcome differences among YW with BC (YWBC). Methods: YW diagnosed with stage I-III BC between 2000−2014 were identified through nine cancer registries. Concordance with international guidelines was assessed for 12 items covering clinical/surgical management, combined in a quality-of-care score. We compared score and survival outcome between the two linguistic-geographic regions of Switzerland (Swiss-Latin and Swiss-German) and evaluated the impact of quality-of-care on survival. Results: A total of 2477 women were included. The median age was 37.3 years (IQR 34.0−39.4 years), with 50.3% having stage II BC and 70.3% having estrogen receptor positive tumors. The mean quality-of-care score was higher in the Latin region compared to the German region (86.0% vs. 83.2%, p < 0.0005). Similarly, 5- and 10-year overall survival rates were higher in the Latin compared to the German region (92.3% vs. 90.2%, p = 0.0593, and 84.3% vs. 81.5%, p = 0.0025, respectively). There was no difference in survival according to the score. In the univariate analysis, women in the Latin region had a 28% lower mortality risk compared to women in the German region (hazard ratio 0.72; 95% CI 0.59−0.89). In the multivariable analysis, only stage, differentiation, tumor subtype and treatment period remained independently associated with survival. Conclusions: We identified geographic disparities in the treatment and outcome of YWBC in Switzerland. National guidelines for YWBC should be implemented to standardize treatment. Awareness should be raised among YW and clinicians that BC does not discriminate by age.

Investigation of the anti-cancer effects of free and PLGA-PAA encapsulated Hydroxytyrosol on the MCF-7 breast cancer cell line

PURPOSE

Breast cancer is the most frequent cancer among women and the most important cause of death. Surgery and chemotherapy are the common treatment of the breast cancer, but increasing drug resistance has created many challenges in its treatment. The present study aimed to investigate the anti-cancer function of free and nano-encapsulated hydroxytyrosol on the MCF-7 breast cancer cell line.

METHODS

The poly lactide-co-glycolide-co-polyacrylic acid (PLGA-co-PAA) nano-encapsulated Hydroxytyrosol was synthesized, and the MTT assay was performed to evaluate the anti-proliferative and anti-tumor effects of both free and nanoencapsulated Hydroxytyrosol. After the extraction of RNA from the treated and control cancer cells, cDNA synthesis was performed and the expression of P21, P27, and Cyclin D1 genes were evaluated by Real-Time PCR.

RESULTS

The results of the study showed that free (12 ppm and 72 hours) and nano-encapsulate (10 ppm and 24 hours) hydroxytyrosol resulted in 50% death (IC50) of the cancer cells and increased by increasing the concentration and time. Also, free and nano-encapsulated hydroxytyrosol increased the expression of P21 and P27 genes and reduced the expression of Cyclin D1 in breast cancer cells. In general, the nano-encapsulated hydroxytyrosol showed more anticancer function than the free hydroxytyrosol.

CONCLUSION

The present study illustrated that the hydroxytyrosol could lead to the cell death in MCF-7 breast cancer by regulating the cell cycle. Also, the nano-encapsulation of Hydroxytyrosol enhanced the Hydroxytyrosol anticancer function by PLGA-co-PAA. However, for more accurate results, further studies on animal models are necessary.

Large regional disparities in prevalence, management and reimbursement of hospital undernutrition

BACKGROUND/OBJECTIVES

Undernutrition is a frequent condition among hospitalized patients, with a significant impact on patient's outcome and hospital costs. Whether undernutrition is reported similarly at the national level has seldom been assessed. We aimed to (1) assess regional differences within Switzerland regarding undernutrition prevalence, management, and cost reimbursement and (2) identify the factors associated with reporting of undernutrition status and its management.

SUBJECTS/METHODS

Observational cross-sectional study including routine statistics from the Swiss hospital discharge databases for years 2013 and 2014 (seven administrative regions). All adults aged ≥20 with length of hospital stay of at least 1 day was included. Reported undernutrition was defined based on the International Classification of Diseases (ICD)-10 codes. Nutritional management and "reimbursable" undernutrition codes were also assessed.

RESULTS

Of the initial 1,784,855 hospitalizations, 3.6% had reported undernutrition, the prevalence ranging between 1.8% (Ticino) and 4.6% (Mittelland). Use of different undernutrition-related ICD-10 codes also varied considerably across regions. Multivariable analysis showed a twofold variation in reported undernutrition: multivariable-adjusted odds ratio and 95% confidence interval relative to Eastern Switzerland: 2.31 (2.23, 2.38) for Mittelland and 0.74 (0.70, 0.79) for Ticino. Over half (59.6%) of hospitalizations with reported undernutrition also included information on undernutrition management, ranging between 28.6% (Ticino) and 67.2% (Zürich). Only one third (36.8%) of undernutrition-related codes were reimbursable, ranging between 8.3% (Ticino) and 50.7% (Zürich).

CONCLUSIONS

In Switzerland, there is considerable regional variation regarding reporting of undernutrition prevalence, management, and cost reimbursement. Undernutrition appears to be insufficiently managed and valued.

The effects of organized screening programs on the demand for mammography in Switzerland

The objective of this study is to estimate the causal effect of organized mammography screening programs on the proportion of women between 50 and 69 years of age who have ever used mammography. We exploit the gradual implementation of organized screening programs in nine Swiss cantons using a difference-in-difference approach. An analysis of four waves of the Swiss Health Survey shows that 3.5-5.4% points of the 87.9% utilization rate in cantons with screening programs in 2012 can be attributed to these organized programs. This effect indicates that organized programs can motivate women who have never done mammography to initiate screening.

Breast cancer survival and health iniquities

Breast cancer is the most frequent neoplasm in women, and some studies have shown social inequalities in incidence and survival, which are poorly investigated in Brazil. To assess iniquity in prognosis, a hospital-based cohort study was carried out. Follow-up was made by active search in medical records and in the Mortality Information System, phone calls, and consultation on Individual Tax-Collection Record status. Survival functions were estimated by the Kaplan-Meier method, and the Cox proportional hazards model was employed for prognostic assessment. Disease-specific survival was estimated at 76.3% (95%CI: 71.9-81.0) in 5 years. Women seen at public facilities had worse prognosis (HR = 1.79; 95%CI: 1.09-2.94), which was particularly due to the disease being diagnosed at a more advanced stage. These findings point to inequalities of access to screening actions, as women of lower social conditions with later diagnostic and therefore with worse prognostic.

Five year survival of women with breast cancer in Yazd

BACKGROUND

Cancer is a non-communicable disease that is considered deadly in many cases. In recent years, the mortality rates from breast cancer have increased with increasing incidences. The present study was conducted to determine five year survival of women with breast cancer in Yazd, in the central region of Iran.

MATERIALS AND METHODS

In a prospective study, data were obtained from the patient's medical records with breast cancer that were referred to the Shahid Sadoughi hospital and radiotherapy center from 2002-2007 and followed up for 5 years. The data collected were analyzed by SPSS/16 and Kaplan-Meyer test and log-rank test and Cox proportional hazard model was used.

RESULTS

The mean age of breast cancer diagnosis was 48.3±11.7 years. The 1-, 2-, 3-, 4- and 5-year cumulative survivals for breast cancer patients were 95%, 86%, 82%, 76% and 70%, respectively. There were significant differences with age distribution (p=0.006). A significant decrease in the 5-year survival in patients with involvement of lymph nodes was lso observed.

CONCLUSIONS

Education for early diagnosis in women must be considered and these findings support the need for breast cancer screening programs.

A registry study of the association of patient's residence and age with colorectal cancer survival

Because of limited literature from rural states of the United States like Nebraska, we evaluated the association of patient's age, Office of Management and Budget residence-county categories (rural-nonmetro, micropolitan-nonmetro, urban), and significant interactions between confounding-variables with colorectal cancer (CRC) survival. This retrospective 1998-2003 study of 6561 CRC patients from the Nebraska Cancer Registry showed median patient survival in colon and rectal cancer in urban, rural and micropolitan counties were 33, 36, and 46 months and 41, 47, 49 months, respectively. In Cox proportional-hazards analyses, after adjusting for significant demographics (age, race, marital status in colon cancer; age, insurance status in rectal cancer), cancer stage, surgery and radiation treatments; 1) no-chemotherapy urban colon cancer patients had significantly shorter survival (rural vs urban; adjusted hazard ratio, HR: 0.78 or urban vs rural HR: 1.28; micropolitan vs urban, HR: 0.78) and 2) no-surgery urban (vs rural, HR: 1.49); micropolitan (vs rural, HR: 2.01) rectal cancer patients had significantly shorter survival. Colon cancer (≥65 years) and rectal cancer (≥75 years) elderly each versus patients aged 19-64 years old had significantly shorter survival (all p < 0.01). The association of patients' age and treatment/residence-county interactions with CRC survival warrant decision-makers' attention.

The relationship between selenium levels and breast cancer: a systematic review and meta-analysis

Breast cancer is the most common cancer type. In several studies, hints have been provided that there is a correlation between selenium deficiency and the incidence of breast cancer. Findings of these published reports are, however, inconsistent. This study serves as a pioneering study aiming at combining the results of studies using a meta-analytic method. A total of 16 articles published between 1980 and 2012 worldwide were selected through searching PubMed, Scopus, and Google scholar databases, and the information were analyzed using a meta-analytic method [random effects model]. I (2) statistics were used to examine heterogeneity. The information was then analyzed by STATA version 12. In this study, due to the non-uniform methods used to measure selenium concentrations, selenium levels were measured in the various subgroups in both case and control groups. There were significant correlations between selenium concentration and breast cancer [P<0.05]. Hence, the mean risk differentiating criteria were estimated to be 0.63 [95% confidence interval [95% CI] 0.93 to 0.32] in serum and toenails. Subgroup analysis showed that the value in toenails was -0.07 [95% CI -0.16 to 0.03] and in serum -1.04 [95% CI 1.71 to -0.38]. In studies in which selenium concentrations were measured in serum, a significant correlation was observed between selenium concentration and breast cancer. In contrast, in studies in which selenium concentration was measured in toenails, the correlation was not significant. Therefore, the selenium concentration can be used as one predictor for breast cancer.

Do sintoma ao tratamento adjuvante da mulher com câncer de mama

Estudo descritivo, com abordagem quantitativa, que identificou o perfil social, clínico e demográfico, e o intervalo de tempo entre as etapas diagnósticas e terapêuticas, do sintoma ao tratamento adjuvante das mulheres com câncer de mama tratadas em instituição oncológica de Santa Catarina, Brasil. Os dados foram coletados por entrevista e nos prontuários de treze mulheres, de agosto a dezembro de 2010. A análise foi sustentada por recomendações científicas para tratamento do câncer de mama e estatística descritiva. Os resultados demonstram a incidência elevada da doença nas mulheres entre 40-49 anos, casadas e com escolaridade até o ensino fundamental. A mediana dos intervalos de tempo até o início do tratamento foi de 245 dias e mais 54 dias para a adjuvância. Os achados evidenciam o estadiamento avançado e justificam a urgência para a implementação do cuidado à mulher com câncer de mama e da Política Nacional de Atenção Oncológica.

Modeling of breast cancer prognostic factors using a parametric log-logistic model in Fars province, Southern Iran

In general, breast cancer is the most common malignancy among women in developed as well as some developing countries, often being the second leading cause of cancer mortality after lung cancer. Using a parametric log-logistic model to consider the effects of prognostic factors, the present study focused on the 5-year survival of women with the diagnosis of breast cancer in Southern Iran. A total of 1,148 women who were diagnosed with primary invasive breast cancer from January 2001 to January 2005 were included and divided into three prognosis groups: poor, medium, and good. The survival times as well as the hazard rates of the three different groups were compared. The log-logistic model was employed as the best parametric model which could explain survival times. The hazard rates of the poor and the medium prognosis groups were respectively 13 and 3 times greater than in the good prognosis group. Also, the difference between the overall survival rates of the poor and the medium prognosis groups was highly significant in comparison to the good prognosis group. Use of the parametric log-logistic model - also a proportional odds model - allowed assessment of the natural process of the disease based on hazard and identification of trends.

Taxa de sobrevida na mulher com câncer de mama: estudo de revisão

Revisão integrativa que identificou nas publicações da LILACS, SciELO e PubMed, período 2004-2009, fatores contribuintes para a elevação das taxas de sobrevida em cinco anos e sobrevida livre de doenças em cinco anos das mulheres com câncer de mama. Os resultados, 40 publicações, demonstraram maior incidência da doença nas idades 50-60 e 40-49 anos. Programas de rastreamento, elevação da escolaridade, do padrão socioeconômico, métodos diagnósticos genéticos, imuno-histoquímicos e citológicos, associação das novas terapêuticas com as convencionais são fatores contribuintes para elevação das taxas de sobrevidas, da qualidade de vida e do cuidado à mulher com câncer de mama.

Breast cancer management and outcome according to surgeon's affiliation: a population-based comparison adjusted for patient's selection bias

BACKGROUND

Studies have reported that breast cancer (BC) units could increase the quality of care but none has evaluated the efficacy of alternative options such as private BC networks, which is our study objective.

PATIENTS AND METHODS

We included all 1404 BC patients operated in the public unit or the private network and recorded at the Geneva Cancer Registry between 2000 and 2005. We compared quality indicators of care between the public BC unit and the private BC network by logistic regression and evaluated the effect of surgeon's affiliation on BC-specific mortality by the Cox model adjusting for the propensity score.

RESULTS

Both the groups had high care quality scores. For invasive cancer, histological assessment before surgery and axillary lymph node dissection when indicated were less frequent in the public sector (adjusted odds ratio (OR): 0.4, 95% confidence interval (CI) 0.3-0.7, and OR: 0.4, 95% CI 0.2-0.8, respectively), while radiation therapy after breast-conserving surgery was more frequent (OR: 2.5, 95% CI 1.4-4.8). Surgeon affiliation had no substantial effect on BC-specific mortality (adjusted hazard ratio (HR): 0.8, 95% CI 0.5-1.4).

CONCLUSIONS

This study suggests that private BC networks could be an alternative to public BC units with both structures presenting high quality indicators of BC care and similar BC-specific mortality.

Prevalence of breast cancer in a defined population of iran

Background

Prevalence of breast cancer in Asian developing countries is much lower than western developed countries. The main aim of this study was to measure breast cancer prevalence in a defined population of Iran.

Methods

A total of 25201 women who were under coverage of “Imam Khomeini Relief Foundation (IKRF)”, which is an organization for delivering supportive social and cultural services to the deprived and poor subgroups of the society, were involved in the study. The study was conducted during years 2007 and 2008. All subjects were interviewed for their socio-demographic features and underwent precise clinical and para-clinical breast examination.

Results

Mean age was 47 years with standard deviation 10 ranging from 11 to 88 years. Subjects were from deprived subgroups of the community; were mainly illiterate or had primary school education (86%) and majority of them (93%) had their first full-term pregnancy at age less than 26 years and also were multiparous. With confirmed diagnosis by breast biopsy, breast cancer prevalence was 0.15% (95%CI; 0.10-0.20).

Conclusion

Compared with developed countries, Asian developing countries have been at a lower risk of breast cancer development. It is seen that more deprived subgroups are at much lower risk. The more industrialized life is accompanied with more hazards.

Causes of death and relative survival of older women after a breast cancer diagnosis

PURPOSE

To understand the impact of breast cancer on older women's survival, we compared survival of older women diagnosed with breast cancer with matched controls. METHODS Using the linked 1992 to 2003 Surveillance, Epidemiology, and End Results (SEER) -Medicare data set, we identified women age 67 years or older who were newly diagnosed with ductal carcinoma in situ (DCIS) or breast cancer. We identified women not diagnosed with breast cancer from the 5% random sample of Medicare beneficiaries residing in SEER areas.We matched patient cases to controls by birth year and registry (99% or 66,039 [corrected] patient cases matched successfully). We assigned the start of follow-up for controls as the patient cases' date of diagnosis. Mortality data were available through 2006. We compared survival of women with breast cancer by stage with survival of controls using multivariable proportional hazards models adjusting for age at diagnosis, comorbidity, prior mammography use, and sociodemographics. We repeated these analyses stratifying by age.

RESULTS

Median follow-up time was 7.7 years. Differences between patient cases and controls in sociodemographics and comorbidities were small (< 4%). Women diagnosed with DCIS (adjusted hazard ratio [aHR], 0.7; 95% CI, 0.7 to 0.7) or stage I disease (aHR, 0.8; 95% CI, 0.8 to 0.8) had slightly lower mortality than controls.Women diagnosed with stage II disease or higher had greater mortality than controls (stage II disease:aHR, 1.2; 95% CI, 1.2 to 1.2). The association of a breast cancer diagnosis with mortality declined with age among women with advanced disease [corrected].

CONCLUSION

Compared with matched controls, a diagnosis of DCIS or stage I breast cancer in older women is associated with better [corrected] survival, whereas a diagnosis of stage II or higher breast cancer is associated with worse survival.

Predictors of state-of-the-art management of early breast cancer in Switzerland

BACKGROUND

The aim of this study was to investigate predictors of state-of-the-art management of early breast cancer in Switzerland.

PATIENTS AND METHODS

The study included 3499 women aged 25-79 years diagnosed with invasive breast cancer stages I-IIIA in 2003-2005. Patients were identified through population-based cancer registries and treated in all kinds of settings. Concordance with national and international recommendations was assessed for 10 items covering surgery, radiotherapy, systemic adjuvant therapy and histopathology reporting. We used multivariate logistic regression to identify independent predictors of high (10 points) and low (≤7 points) concordance.

RESULTS

In one-third of the patients, management met guidelines in all items, whereas in about one-fifth, three or more items did not comply. Treatment by a surgeon with caseload in the upper tercile and team involved in clinical research were independent predictors of a high score, whereas treatment by a surgeon with a caseload in the lower tercile was associated with a low score. Socioeconomic characteristics such as income and education were not independent predictors, but patient's place of residence and age independently predicted management according to recommendations.

CONCLUSION

Specialization and involvement in clinical research seem to be key elements for enhancing the quality of early breast cancer management at population level.

Geographic variation in breast cancer care in Switzerland

PURPOSE

Regional disparities in breast cancer outcomes have been reported in Switzerland. The purpose of this study is to investigate geographic variation in early diagnosis and management of breast cancer.

METHODS

We used data from a representative sample of 4820 women diagnosed with invasive breast cancer between January 1, 2003 and December 31, 2005 identified by seven Swiss population based cancer registries. We collected retrospectively detailed information on mode of detection, tumor characteristics and treatments. Differences across geographic regions were tested for statistical significance using chi-square tests and uni- and multivariate logistic regression.

RESULTS

Considerable disparities in early detection and management of early breast cancer were found across regions. In particular, the proportion of early detected cancer varied from 43% in Valais to 27% in St. Gallen-Appenzell. Mastectomy rates varied from 24% in Geneva to 38% in St. Gallen-Appenzell and Grisons-Glarus. Higher reconstruction rates were observed in regions with lower rates of mastectomy. The use of sentinel node procedure in patients with nodal negative disease was high in Geneva and low in Eastern Switzerland. Differences in compliance with recommendations on the use of endocrine therapy and chemotherapy were less pronounced but statistically significant.

CONCLUSIONS

This analysis shows considerable geographic variation in breast cancer care in a health system characterized by high expenditures, universal access to services and high decentralization. Further study into the causes and effects of this variation on short- and long term patient outcomes is needed.

Geographic disparities in colorectal cancer survival

Background

Examining geographic variation in cancer patient survival can help identify important prognostic factors that are linked by geography and generate hypotheses about the underlying causes of survival disparities. In this study, we apply a recently developed spatial scan statistic method, designed for time-to-event data, to determine whether colorectal cancer (CRC) patient survival varies by place of residence after adjusting survival times for several prognostic factors.

Methods

Using data from a population-based, statewide cancer registry, we examined a cohort of 25,040 men and women from New Jersey who were newly diagnosed with local or regional stage colorectal cancer from 1996 through 2003 and followed to the end of 2006. Survival times were adjusted for significant prognostic factors (sex, age, stage at diagnosis, race/ethnicity and census tract socioeconomic deprivation) and evaluated using a spatial scan statistic to identify places where CRC survival was significantly longer or shorter than the statewide experience.

Results

Age, sex and stage adjusted survival times revealed several areas in the northern part of the state where CRC survival was significantly different than expected. The shortest and longest survival areas had an adjusted 5-year survival rate of 73.1% (95% CI 71.5, 74.9) and 88.3% (95% CI 85.4, 91.3) respectively, compared with the state average of 80.0% (95% CI 79.4, 80.5). Analysis of survival times adjusted for age, sex and stage as well as race/ethnicity and area socioeconomic deprivation attenuated the risk of death from CRC in several areas, but survival disparities persisted.

Conclusion

The results suggest that in areas where additional adjustments for race/ethnicity and area socioeconomic deprivation changed the geographic survival patterns and reduced the risk of death from CRC, the adjustment factors may be contributing causes of the disparities. Further studies should focus on specific and modifiable individual and neighborhood factors in the high risk areas that may affect a person's chance of surviving cancer.

Survival analysis of 1148 women diagnosed with breast cancer in Southern Iran

BACKGROUND

While there has been much research regarding risk factors and prognostic factors for breast cancer in general, research specific to Iran is sparse. Further, the association between breast cancer survival and socio-demographic and pathologic factors has been widely studied but the majority of these studies are from developed countries. Southern Iran has a population of approximately 4 million. To date, no research has been performed to determine breast cancer survival and to explore the association between the survival and socio-demographic and pathologic factors in Southern Iran, where this study was conducted.

METHODS

The data were obtained from the cancer registry in Fars province, Southern Iran and included 1148 women diagnosed with breast cancer between 2000 and 2005. The association between survival, and sociodemographic and pathological factors, distant metastasis at diagnosis, and treatment options was investigated using Cox regression.

RESULTS

The majority of patients were diagnosed with an advanced tumour size. Five-year overall survival was 58% (95%CI; 53%-62%). Cox regression showed that family income (good vs poor: hazard ratio 0.46, 95%CI; 0.23-0.90) smoking (HR = 1.40, 95%CI; 1.07-1.86), metastases to bone (HR = 2.25, 95%CI; 1.43-3.52) and lung (HR = 3.21, 95%CI;1.70-6.05), tumour size (< or = 2 cm vs > or = 5 cm: HR = 2.07, 95%CI;1.39-3.09) and grade (poorly vs well differentiated HR = 2.33, 95%CI; 1.52-3.37), lymph node ratio (0 vs 1: HR = 15.31, 95%CI; 8.89-26.33) and number of involved node (1 vs >15: HR = 14.98, 95%CI; 8.83-25.33) were significantly related to survival.

CONCLUSION

This is the first study to evaluate breast cancer survival in Southern Iran and has used a wide range of explanatory factors, 44. The results demonstrate that survival is relatively poor and is associated with diagnosis with late stage disease. We hypothesise that this is due to low level of awareness, lack of screening programs and subsequent late access to treatment.

Effectiveness of organised versus opportunistic mammography screening

BACKGROUND

Detailed comparison of effectiveness between organised and opportunistic mammography screening operating in the same country has seldom been carried out.

PATIENTS AND METHODS

Prognostic indicators, as defined in the European Guidelines, were used to evaluate screening effectiveness in Switzerland. Matching of screening programmes' records with population-based cancer registries enabled to compare indicators of effectiveness by screening and detection modality (organised versus opportunistic screening, unscreened, interval cancers). Comparisons of prognostic profile were also drawn with two Swiss regions uncovered by service screening of low and high prevalence of opportunistic screening, respectively.

RESULTS

Opportunistic and organised screening yielded overall little difference in prognostic profile. Both screening types led to substantial stage shifting. Breast cancer prognostic indicators were systematically more favourable in Swiss regions covered by a programme. In regions without a screening programme, the higher the prevalence of opportunistic screening, the better was the prognostic profile.

CONCLUSIONS

Organised screening appeared as effective as opportunistic screening. Mammography screening has strongly influenced the stage distribution of breast cancer in Switzerland, and a favourable impact on mortality is anticipated. Extension of organised mammography screening to the whole of Switzerland can be expected to further improve breast cancer prognosis in a cost-effective way.