Survival from breast cancer among South Asian and non-South Asian women resident in South East England

Ethnic differences in breast cancer survival have been observed in the USA but have not been examined in Britain. We aimed to investigate such differences between South Asian (i.e. those with family roots in the Indian subcontinent) and non-South Asian (essentially British-native) women in England. Primary breast cancer cases incident in 1986 -1993 and resident in South East England were ascertained through the Thames Cancer and Registry and followed up to the end of 1997. Cases of South Asian ethnicity were identified on the basis of their names by using a previously validated computer algorithm. A total of 1037 South Asian and 50 201 non-South Asian breast cancer cases were included in the analysis; 30% of the South Asian (n=312) and 44% (n=22 201) of the non-South Asian cases died during follow-up. South Asian cases had a higher relative survival than non-South Asians throughout the follow-up period. The 10-year relative survival rates were 72.6% (95% confidence interval: 69.0, 75.9%) and 65.2% (64.5, 65.8%) for South Asians and non-South Asians, respectively. The excess mortality rates experienced by South Asians were 82% (72, 94%) of those experienced by non-South Asians (P=0.004). The magnitude of this effect was slightly reduced with adjustment for differences in age at diagnosis, but was strengthened with further adjustment for differences in stage at presentation and socioeconomic deprivation (excess mortality rates in South Asians relative to non-South Asians=72% (63, 82%), P&<0.001). These findings indicate that the higher survival from breast cancer in the first 10 years after diagnosis among South Asian was not due to differences in age at diagnosis, socioeconomic deprivation or disease stage at presentation

Effects of specialisation on treatment and outcomes in screen-detected breast cancers in Wales: cohort study

Volume–outcome relationships have been found for management of symptomatic but not for screen-detected, breast cancers. The study included 2705 patients with breast cancer detected by the Welsh breast cancer-screening programme from its inception in 1989 to 1997. Survival was tracked until 1999. Data validity was assessed for 10% of subjects. Hospitals' and surgeons' annual patient volumes were calculated as indices of specialisation. Effects of hospital and surgeon volumes on survival were estimated using Cox regression. Surgeons' and hospitals' volumes ranged from 1 to 90, and 1 to 86 patients, respectively. Patients managed by higher volume surgeons survived significantly longer (adjusted hazards ratio for a volume difference of 10 patients per year=0.90 (95% confidence intervals 0.84–0.97)). The adjusted hazard ratio for breast cancer survival was similar (0.91 (95% confidence intervals 0.82–1.00)). This association decreased over time. Patients of higher volume surgeons were significantly more likely to have axillary surgery and impalpable excision biopsies and were less likely to have mastectomy or radiotherapy. Surgeons' specialisation in management of screen-detected breast cancers was associated with longer survival, but this effect appeared to decrease over time

Geographical variation in breast cancer survival rates for women diagnosed in England between 1992 and 1994

The 5-year relative survival rates of women diagnosed with breast cancer between 1992 and 1994 were compared among the 99 Health Authorities (1999 boundaries) of England. Substantial variation, with evidence of geographical clustering was observed. Part of this variation was explained by differences in deprivation between Health Authorities, in particular by the percentage of class IV and V households