Woods, LM

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Woods, LM (2004) International differences in breast cancer survivaland cure with social deprivation a comparative study of England andAustralia (oral presentation). In: UNSPECIFIED.Downloaded from: http://researchonline.lshtm.ac.uk/2121452/DOI:Usage GuidelinesPlease refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alterna-tively contact researchonline@lshtm.ac.uk.Available under license: Copyright the author(s)International differences in breast cancer survival and ‘cure’:impact of social deprivationA comparative study of England and AustraliaLaura M Woods, PhD studentLondon School of Hygiene and Tropical MedicineSupervisor: Professor Michel P ColemanBreast cancer - overview• Worldwide, the most common malignancy in women• 20% of all cancers• 36,000 cases diagnosed in England and Wales during year 2000• 10% of the female population of Leeds Breast cancer overviewSURVIVAL• Increasing age          at first birth and nulliparity• Increasing obesity• ScreeningINCIDENCE MORTALITY• Improvement in hormonal       treatment and surgery• ScreeningMeasuring cancer survival• Preferable measure for patient and clinician• Separate studies are difficult to compare:► Reliant on accurate recording of dates (birth, diagnosis, death)► Different statistical methods► Inclusion (and exclusion) criteriaEuropean comparisons & the EUROCARE projectComparative studies• Survival highest in Sweden, Finland, France and Switzerland• Survival lowest in UK and Eastern Europe• Variation by age where survival is lowCanada and USA (SEER)• Focus on the comparison between deprivation groups• Deprived in USA had lower survival than the deprived in Canada• Conflicting findings:USA>CanadaUSA<CanadaComparative studiesTrans-Atlantic comparisons Europe and USAComparative studies• Survival in USA higher than all 17 European countries included • Pooled European five-year survival rate 10% lower than for USACancer survival in developing countries (IARC)Comparative studies• Survival lower than USA or Europe• Highest in urban China The CONCORD studyComparative studies• International collaboration of cancer registries• In progress (results expected 2005)• Comparable data• Comparable statistical methods• National and sub-national analyses• Adequate adjustment for age at diagnosis• Multi-variate analyses• Inclusion of diagnostic delay and treatment• Adjustment for deprivationImplications from literature review• Extend comparative studies to Australasia• Important similarities ► Nationalised health care► Caucasian population► National cancer registration• Important differences► Survival rates► Deprivation gap in survivalComparison of breast cancer survival in Australia and EnglandSurvival contrasts606570758085Australia England andWalesFive-year relative survival (%)1992-19971987-19911982-19861992-19971987-19911982-19863040506070809020-29 40-49 60-69 80-89AustraliaEngland and WalesAge at diagnosisFive –year relative survival (%)Survival contrastsIncreasing deprivationIncreasing survivalAustralia AustraliaEnglandEnglandSurvival contrastsAustraliaEngland & WalesTime since diagnosis (years)Relative survival (%)Survival contrasts0204060801000 5 10 15 0 5 10 15‘Cured’ proportion‘Cured’ proportionUnequal    five-year survival rates• Describe epidemiology of breast cancer• Quantify the Australian advantage• Compare the proportion ‘cured’• Investigate reasons for differences► Between Australia and England► Within Australia and England• Investigate the role of within-country variability in international differencesAims• National data (‘big picture’) and registry data (detailed analyses)• Incidence, relative survival and ‘cure’• Several covariates:► deprivation category► age at diagnosis► stage of disease at diagnosis► screening history► time period of diagnosisPlanned analysis• Population 5.3 million (West Midlands)6.4 million (New South Wales)• Register c.3000 breast cancer cases per year• Consistent geographic boundaries 1980-2004• Screening history available for all women through national screening programmeWest Midlands Cancer Intelligence Unit New South Wales Central Cancer RegistryData: Breast cancers 1980-2004Variables requiredNational DataRegistry DataPatient and tumour identifiers X XDates of birth, diagnosis and death or censoringX XData quality indicators X XRegion/ State at diagnosis XArea-based deprivation category XTumour characteristics XScreening history X• No individual measure in cancer registry data• Area-based scores (census data)• Several indices available ► Carstairs, Townsend, IMD (England)► Townsend, SEIFA (Australia)• Several possible geographies► English EDs (’91), OAs, Super-OAs (‘01), wards► Australian Collection districts (CDs)Measuring deprivation• Relative survival analysis ► Adjusts for background mortality► Permits valid comparisons between different groups of cancer patients► Country- and deprivation-specific life tables • Age standardisation of survival• Cure analysis► Testing of currently available models► Development of a more robust cure modelMethodsResearch conducted in collaboration with theWest Midlands Cancer Intelligence Unitand theNew South Wales Central Cancer Registry Laura Woods is funded by a Medical Research Council PhD Studentship 2003-2006

International differences in breast cancer survival and ‘cure’ with social deprivation a comparative study of England and Australia (oral presentation)

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International differences in breast cancer survival and ‘cure’ with social deprivation a comparative study of England and Australia (oral presentation)

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