Retrospective study of reasons for improved survival in patients with breast cancer in East Anglia: Earlier diagnosis or better treatment?
Retrospective study of reasons for improved survival in patients with breast cancer in East Anglia: Earlier diagnosis or better treatment?
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DOI：
10.1136/bmj.314.7079.472
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发表时间：
1997-02-15
影响因子：
--
通讯作者：
McCann, J
中科院分区：
文献类型：
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作者：
Stockton, D;Davies, T;McCann, J
目的：调查最近英格兰和威尔士乳腺癌死亡率的下降，并确定治疗和肿瘤早期检测的改进的相对贡献。设计：回顾性研究在东安格利亚癌症登记处登记并在1982年至1989年间诊断的所有乳腺癌妇女。研究对象：1982-5年确诊的3965例患者与1986-9年确诊的4665例患者比较，分为0-49岁、50-64岁、大于或等于65岁三个年龄组，提供诊断时分期和生存期信息。主要结局指标：按时间段、年龄组和分期划分的三年相对生存率；每个时间段和年龄组的相对风险比，由Cox比例风险模型得出，并根据年龄和阶段进行调整。结果：生存率在后期有所提高，但没有明显的阶段性改善。早期肿瘤的比例增加，特别是在50-64岁年龄组中，65岁以下妇女生存改善的一半以上是分期调整。结论：65岁以下妇女死亡率下降的一半以上似乎是由于早发现肿瘤，这是自1980年代中期以来观察到的。这可能是由于在乳房筛查项目开始之前，人们对乳房的认识有所提高。
Objectives: To investigate the recent fall in mortality from breast cancer in England and Wales, and to determine the relative contributions of improvements in treatment and earlier detection of tumours.Design: Retrospective study of all women with breast cancer registered by the East Anglian cancer registry and diagnosed between 1982 and 1989.Subjects: 3965 patients diagnosed 1982-5 compared with 4665 patients diagnosed 1986-9, in three age groups 0-49, 50-64, greater than or equal to 65 years, with information on stage at diagnosis and survival.Main outcome measures: Three year relative survival rates by time period, age group, and stage; relative hazard ratios for each time period and age group derived from Cox's proportional hazards model, adjusted for single year of age and stage.Results: Survival improved in the later time period, although there was little stage specific improvement. The proportion of early stage tumours increased especially in the 50-64 year age group, and adjustment for stage accounted for over half of the improvement in survival in women aged under 65 years.Conclusion: Over half of the drop in mortality in women aged under 65 years seems to be attributable to earlier detection of tumours, which has been observed since the mid-1980s. This could have resulted from an increase in breast awareness predating the start of the breast screening programme.