Background: Data from a long-established hospital-based cancer registry were used to analyse the relationship between clinical and organisational factors and disease-specific survival among women with primary breast cancer.
Methods: 2023 women with incident invasive breast cancer diagnosed from 1992 to 2005 were identified through the Hospital del Mar Cancer Registry (Barcelona, Spain). Patients were followed until December 2008. One-, 5- and 10-year disease-specific survival rates were estimated. Kaplan-Meier and Cox regression models were used to analyse death from breast cancer.
Results: At diagnosis 70.2% of tumours were in stages I-II. During follow-up 705 deaths occurred, 58.4% specifically due to breast cancer. Five- and 10-year breast cancer specific survival rates were 83.3% and 73.7%, respectively (stage I, 97.1% and 94.0%; stage II, 88.0% and 79.4%; stage III, 70.1% and 46.3%, and stage IV, 24.5% and 6.1%, respectively). The 5-year disease-specific survival rate increased from 73.5% in 1992-1995 to 86.4% in 2001-2005 (log rank, p<0.001). Multivariate analyses showed that prognosis was less favourable for women diagnosed between 1992 and 1995, for those whose route to diagnosis was not the screening programme, women aged ≥ 70 years, with stage IV tumours, with high grade lesions, and for women who received only palliative or symptomatic treatment. Adjusting for prognostic factors, surgeon's experience did not significantly appeared to affect survival of operated women.
Conclusions: In this centre survival from breast cancer improved markedly from 1992 to 2005. Breast cancer prognosis was influenced by both clinical and organisational variables. The quantification of the role of such factors affords valuable knowledge to improve cancer care in settings similar to the study hospital.
Copyright © 2012 Elsevier Ltd. All rights reserved.