Autier P, Boniol M, La Vecchia C, Vatten L, Gavin A, Hery C, Heanue MDisparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database. BMJ 341: c3620

International Agency for Research on Cancer, Lyon, France.
BMJ (online) (Impact Factor: 17.45). 08/2010; 341(aug11 1):c3620. DOI: 10.1136/bmj.c3620
Source: PubMed


To examine changes in temporal trends in breast cancer mortality in women living in 30 European countries.
Retrospective trend analysis. Data source WHO mortality database on causes of deaths Subjects reviewed Female deaths from breast cancer from 1989 to 2006
Changes in breast cancer mortality for all women and by age group (<50, 50-69, and >or=70 years) calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in all age mortality began to change.
From 1989 to 2006, there was a median reduction in breast cancer mortality of 19%, ranging from a 45% reduction in Iceland to a 17% increase in Romania. Breast cancer mortality decreased by >or=20% in 15 countries, and the reduction tended to be greater in countries with higher mortality in 1987-9. England and Wales, Northern Ireland, and Scotland had the second, third, and fourth largest decreases of 35%, 29%, and 30%, respectively. In France, Finland, and Sweden, mortality decreased by 11%, 12%, and 16%, respectively. In central European countries mortality did not decline or even increased during the period. Downward mortality trends usually started between 1988 and 1996, and the persistent reduction from 1999 to 2006 indicates that these trends may continue. The median changes in the age groups were -37% (range -76% to -14%) in women aged <50, -21% (-40% to 14%) in 50-69 year olds, and -2% (-42% to 80%) in >or=70 year olds.
Changes in breast cancer mortality after 1988 varied widely between European countries, and the UK is among the countries with the largest reductions. Women aged <50 years showed the greatest reductions in mortality, also in countries where screening at that age is uncommon. The increasing mortality in some central European countries reflects avoidable mortality.

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Available from: Mathieu Boniol, Feb 17, 2015
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    • "During the last decade, the incidence and mortality rate of breast cancer remained stable or even declined in some developed countries (Amaro et al., 2013; Autier et al., 2010). Reduction of mortality rate was attributed to earlier detection through mammography screening, therapeutic treatment advances and reduced use of menopausal hormone therapy (Jemal et al., 2011; Ravdin et al., 2007). "
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    DESCRIPTION: Missing implementation of immunohistochemistry (IHC) assays in public hospitals of North-eastern Brazil represents a serious access barrier to a diagnostic service of the public health system. The present study aimed on comparison of clinical- histopathological characteristics between breast cancer patients, who have and have not performed immunohistochemistry assays. Data of 677 patients with invasive breast cancer, registered in the years between 2005 and 2010, were obtained from medical records of a public hospital in Campina Grande, Paraíba, Brazil. Overall, 384 (56.72%) out of 677 patients have not performed IHC assays. Increased tumor size (OR= 2.08; CI= 1.27- 3.45; p= 0.0030) and high histological grade (OR= 2.17; CI= 1.18- 4.17; p= 0.0130), were associated with decreased five- year survival. Five- year survival rates were 89.42% and 83.85% for patients who have and have not performed IHC assays, respectively (p= 0.0329). The hazard ratio was 1.580 (95% CI of ratio: 1.045 to 2.369).Patients who have not performed IHC assays reached hospital in a more severe state of disease. This indicated that patients who have not performed IHC assays suffered a time delay, between discoveries of first disease symptoms and begins of breast cancer treatment.
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    • "Moreover, it has been suggested that under-treatment of older people could, at least in part, explain the disparities in cancer survival observed both within and between countries with seemingly similar health care systems [7] [8] [9]. In this regard, UK cancer services have been at the centre of many of these discussions; with particular concerns being raised about equity in the provision of chemotherapy for potentially curable cancers [6] [7] [9] [10]. "
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    ABSTRACT: To examine the influence of patient's age and socio-economic status on treatment and outcome in diffuse large B-cell lymphoma (DLBCL); an aggressive curable cancer, with an incidence rate that increases markedly with age but varies little with socio-economic status. Set within a representative UK population of around 4 million, data are from an established patient cohort. This report includes all patients (≥18years) newly diagnosed with DLBCL 2004-2012, with follow-up to February 2015. Of the 2137 patients (median age 70.2 years) diagnosed with denovo DLBCL, 1709 (80%) were treated curatively/intensively and 1161(54.3%) died during follow-up. Five-year overall and relative survival (RS) estimates were 46.2% (95% CI 44.0-48.4%) and 54.6% (52.1%-57.0%) respectively for all patients, and 58.5% (56.1-60.9%) and 67.0% (64.3-69.6%) for intensively treated patients. 96.3% of patients <55 years (366/380) and 96.4% of those with the best performance status (543/563) were treated curatively: 5-year RSs being 77.9% (73.1-82%) and 87.1% (82.5-90.6%) respectively. At the other end of the age/fitness spectrum, 33.3% of those ≥85 years (66/198) and 41.1% with the worst performance (94/225) were treated curatively: the corresponding 5-year RSs being 50.5% (27.1-69.0%) and 22.9% (14.0-33.2%). The proportion of patients whose cancer was fully staged fell with increasing age and worsening performance status. No socio-economic variations with treatment, stage at presentation or outcome were detected. Performance status is more discriminatory of survival than chronological age, with fitter patients benefiting from treatment across all ages. Socio-economic factors are not predictive of outcome in patients with DLBCL in the UK. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
    09/2015; DOI:10.1016/j.canep.2015.08.015
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    • "Breast cancer is a leading cause of death among women worldwide (Jemal et al, 2011). Breast cancer mortality has declined in western countries because of multidisciplinary efforts over the last decade, including improved detection through screening, increased specialisation of care (Kingsmore et al, 2003), and better access to more effective treatments, such as improved surgical techniques, targeted radiotherapy, and adjuvant therapies, including tamoxifen (Autier et al, 2010). Nevertheless, clinical outcomes in metastatic breast cancer (MBC) remain poor, and identification of therapeutics to improve treatment is necessary. "
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    ABSTRACT: Background: We evaluated the safety, maximum-tolerated dose (MTD), pharmacokinetics, recommended dose for phase II (P2RD), and preliminary anticancer activity of a combination eribulin and S-1 therapeutic in metastatic breast cancer patients pretreated with anthracycline and taxane. Method: Patients aged 20-74 years were recruited. In level 1, patients received S-1 (65 mg m(-2)) from day 1 to 14, and eribulin (1.1 mg m(-2)) on day 1 and 8 in a 21-day cycle. In level 2, eribulin was increased to 1.4 mg m(-2). In level 3, S-1 was increased to 80 mg m(-2). Results: Twelve patients were enrolled into three cohorts. Planned dose escalation was completed, with one case exhibiting dose-limiting toxicity (grade 3 hypokalaemia) at level 3, without reaching the MTD. The P2RD was determined to be level 2 (eribulin 1.4 mg m(-2) and S-1 65 mg m(-2)). The most common grade 3 or 4 toxicity was neutropenia (83.3%), followed by febrile neutropenia (25.0%). Five of eleven patients (41.7%) with measurable disease had a partial response. Pharmacokinetics were characterised by dose-dependent elimination and nonlinear exposure. Conclusion: Dose level 3 was not tolerated owing to febrile neutropenia development. Thus, intermediate dose level 2 was recommended for further evaluation. Preliminary antitumour activity warrants further investigation in this setting.
    British Journal of Cancer 02/2015; 112(5). DOI:10.1038/bjc.2015.10 · 4.84 Impact Factor
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