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Differences in management of older women influence breast cancer survival: results from a population-based database in Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery. (Gastrointestinal Surgery)
2006 (English)In: PLoS Medicine, ISSN 1549-1676, Vol. 3, no 3, e25- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Several reports have shown that less aggressive patterns of diagnostic activity and care are provided to elderly breast carcinoma patients. We sought to investigate whether differences in the management of older women with breast cancer are associated with survival. METHODS AND FINDINGS: In an observational study using a population-based clinical breast cancer register of one health-care region in Sweden, we identified 9,059 women aged 50-84 y diagnosed with primary breast cancer between 1992 and 2002. The 5-y relative survival ratio was estimated for patients classified by age group, diagnostic activity, tumor characteristics, and treatment. The 5-y relative survival for breast cancer patients was lower (up to 13%) in women 70-84 y of age compared to women aged 50-69 y, and the difference was most pronounced in stage IIB-III and in the unstaged. Significant differences in disease management were found, as older women had larger tumors, had fewer nodes examined, and did not receive treatment by radiotherapy or by chemotherapy as often as the younger women. Adjustment for diagnostic activity, tumor characteristics, and treatment diminished the relative excess mortality in stages III and in the unstaged, whereas the excess mortality was only marginally affected in stage IIB. CONCLUSIONS: Less diagnostic activity, less aggressive treatment, and later diagnosis in older women are associated with poorer survival. The large differences in treatment of older women are difficult to explain by co-morbidity alone.

Place, publisher, year, edition, pages
2006. Vol. 3, no 3, e25- p.
Keyword [en]
Age Distribution, Aged, Aged; 80 and over, Breast Neoplasms/diagnosis/*mortality/pathology/*therapy, Confidence Intervals, Databases; Factual, Female, Humans, Middle Aged, Neoplasm Staging, Survival Analysis, Sweden/epidemiology
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-26608DOI: 10.1371/journal.pmed.0030025PubMedID: 16409108OAI: oai:DiVA.org:uu-26608DiVA: diva2:54382
Available from: 2008-02-14 Created: 2008-02-14 Last updated: 2009-07-22Bibliographically approved

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Bergkvist, LeifHolmberg, Lars

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Department of Surgical SciencesEndocrine SurgeryCentre for Clinical Research, County of Västmanland
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