English women ages 70 and older are less likely to survive breast cancer than women of the same age in Belgium, Poland, the Republic of Ireland, and the Netherlands, according to research published online on 7 June in the British Journal of Cancer.
In one of the largest studies of its kind looking at older breast cancer patients, the research team led by Dr. Marloes Derks from the surgery department at Leiden University Medical Center in Leiden, the Netherlands, ranked the five countries for five-year survival of breast cancer at stage II and III. The group found England ranked the worst.
"The fact that breast cancer mortality in England is higher than in other countries in this study even for those women whose cancer is in its earliest stage suggests there is something more at play than just a failure to diagnose it early," Derks said in a release from Cancer Research UK. "We were surprised to see England had lower levels of breast cancer surgery and further research is needed to establish whether these two factors are linked."
Derks and colleagues analyzed the anonymized records of 236,015 women who'd been diagnosed with breast cancer before it spread. They also looked at treatment methods. The proportion of stage I breast cancer patients receiving endocrine therapy ranged from 19.6% in the Netherlands to 84.6% in Belgium. The proportion of stage III breast cancer patients receiving no breast surgery varied between 22% in Belgium and 50.8% in the Republic of Ireland. For stage III breast cancer, England, the Republic of Ireland, and Poland showed significantly worse relative survival compared with Belgium.
English patients with stage I or II breast cancer were most likely to have no surgery as part of their treatment compared with other countries, the researchers also found.
Not having surgery at stage III was found to be linked to poorer survival. In England, 44% of patients received no surgery at stage III, compared with 22% of patients in Belgium. Overall, the number of patients with stage III breast cancer surviving their disease for five years or more in England was 12% lower than in Belgium (60%).
"We know that surgery is one of the most effective treatments for breast cancer so it's vital that women in England aren't missing out on surgical treatment that could save their lives," said Arnie Purushotham, senior clinical adviser at Cancer Research UK. "We need to better understand why patients in England are less likely to have surgery than their European counterparts. Surgery should be considered in all older patients who are fit to undergo this treatment."
