Breast cancer incidence and survival: registry-based studies of long-term trends and determinants

__Abstract__ Breast cancer is the most frequent cancer among women in the Netherlands, and it is the most important cause of cancer death. Between age 35 and 55 about 20% of all deaths among women is due to breast cancer.1 The age-standardised incidence rate is among the highest in Europe/ and incidence rates have been increasing since 1960.3 The mortality from breast cancer has been fairly stable for many years, but decreased somewhat in the last decade (figure 1). The detection of (early) breast cancer has been facilitated by the introduction and increased use of mammography and cytology since the 1980s. The implementation of the mass breast cancer screening programme between 1991 and 1996 further increased the incidence of breast cancer, also because of an increased awareness in the population. However, any increase associated with early detection would be temporary. Some of the screen-detected tumours would never have been diagnosed without a mass screening programme, so some of the increase is likely to be artificial

Excess mortality from breast cancer 20 years after diagnosis when life expectancy is normal

In a population-based study, causes of death were traced of 418 deceased breast cancer patients diagnosed in 1960–1979 who survived at least 10 years after diagnosis. The pattern of causes of death in these patients was compared with the general female population using standardized mortality ratios (SMRs). Of 418 patients surviving at least 10 years, 196 (47%) died from breast cancer and 50 (12%) died from another cancer. The SMR for breast cancer was 15.8 (95% CI: 13.1–18.8) 10–14 years after diagnosis; it was still 4.7 (95% CI: 2.6–7.8) after 20 years. Overall mortality was higher than expected 10–14 years after diagnosis (SMR: 1.3; 95% CI: 1.1–1.5), but lower after more than 20 years (SMR: 0.6; 95% CI: 0.4–0.7). Despite a normal (or even improved) life expectancy for breast cancer patients 20 years after diagnosis the risk of dying from this disease remained elevated. © 2001 Cancer Research Campaign http://www.bjcancer.co

Rising incidence of breast cancer among female cancer survivors: implications for surveillance.

The number of female cancer survivors has been rising rapidly. We assessed the occurrence of breast cancer in these survivors over time. We computed incidence of primary breast cancer in two cohorts of female cancer survivors with a first diagnosis of cancer at ages 30+ in the periods 1975–1979 and 1990–1994. Cohorts were followed for 10 years through a population-based cancer registry. Over a period of 15 years, the incidence rate of breast cancer among female cancer survivors increased by 30% (age-standardised rate ratio (RR-adj): 1.30; 95% CI: 1.03–1.68). The increase was significant for non-breast cancer survivors (RR-adj: 1.41, 95% CI: 1.04–2.75). During the study period, the rate of second breast cancer stage II tripled (RR-adj: 3.10, 95% CI: 1.73–5.78). Non-breast cancer survivors had a significantly (P value=0.005) more unfavourable stage distribution (62% stage II and III) than breast cancer survivors (32% stage II and III). A marked rise in breast cancer incidence among female cancer survivors was observed. Research to optimise follow-up strategies for these women to detect breast cancer at an early stage is warranted

Increase of sentinel lymph node melanoma staging in The Netherlands; still room and need for further improvement

Aim: To investigate implementation of the seventh American Joint Committee on Cancer melanoma staging with sentinel lymph node biopsy (SLNB) and associations with socioeconomic status (SES). Patients & methods: Data from The Netherlands Cancer Registry on patient and tumor characteristics were analyzed for all stage IB-II melanoma cases diagnosed 2010-2016, along with SES data from The Netherlands Institute for Social Research. Results: The proportion of SLNB-staged patients increased from 40% to 65% (p <0.001). Multivariate analysis showed that being female, elderly, or having head-and-neck disease reduced the likelihood of SLNB staging. Conclusion: SLNB staging increased by 25% during the study period but lagged among elderly patients and those with head-and-neck melanoma. In The Netherlands, SES no longer affects SLNB staging performance

Cumulative incidence and timing of subsequent cutaneous squamous cell carcinomas stratified for patients with organ transplantation and hematologic malignancies:A nationwide cohort study

Background: There is lack of nationwide data on the cumulative incidence and timing of subsequent cutaneous squamous cell carcinomas (cSCCs) among patients with a first cSCC. Objective: To investigate the cumulative incidence and timing of subsequent cSCCs. Methods: Patients with a first cSCC in 2007/2008 from the Netherlands Cancer Registry were linked to the Netherlands Pathology Registry for subsequent cSCCs and the Netherlands Organ Transplant Registry. Cumulative incidence function curves were calculated for subsequent cSCCs and stratified for immune status. Results: Among the 12,345 patients, second to sixth cSCC occurred in 4325, 2010, 1138, 739, and 501 patients, with median time intervals of 1.4, 1.2, 0.9, 0.6, and 0.5 years after the previous cSCC, respectively. The cumulative incidence of a subsequent cSCC at 5 years increased from 28% to 67% for the second to sixth cSCC. For solid organ transplant recipients, the cumulative incidences increased from 74% to 92% and from 41% to 64% for patients with hematologic malignancy. Limitations: Only histopathologically confirmed cSCCs were included. Conclusion: The risk of a subsequent cSCC steeply rises with the number of prior cSCCs and immune status, while the time interval decreases. This can support more informed decisions about follow-up management.</p