Coleman, MP

Lawrence, GL

O’Connell, D

Rachet, B

Woods, LM

LSHTM Research Online

Woods, LM; Rachet, B; OConnell, D; Lawrence, GL; Coleman, MP(2012) The impact of screen-detection upon international differencesin survival from breast cancer: a comparison of the West Midlands,England, and New South Wales, Australia (poster presentation). In:UNSPECIFIED.Downloaded from: http://researchonline.lshtm.ac.uk/2121485/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)Results A significant difference in net survival between women diagnosed in New South Wales and the West Midlands (Figure 2) Survival for screen-detected women similar (Figure 3)               Differences smaller for women who had attended screening (Figure 4)               Lead time adjusted estimates lower (Figure 5) Non-significant survival difference between New South Wales and West Midlands in adjusted estimates (Figure 6)               Excess hazard ratios: regional differences in survival were greatest during the first three years following diagnosis (Figure 7). Title Verdana  Bold 72pt improving health worldwide                 www.lshtm.ac.uk  The impact of screen-detection upon international  differences in survival from breast cancer:  a comparison of the West Midlands, England, and New South Wales, Australia Laura M Woods1 Bernard Rachet1  Dianne O’Connell2 Gill Lawrence3 Michel P Coleman1  1 London School of Hygiene and Tropical Medicine, London, UK 2 Cancer Epidemiology Research Unit, Cancer Council NSW, Sydney, Australia  3 West Midlands Cancer Intelligence Unit, University of Birmingham, Birmingham, UK Introduction  Our previous results: a significant difference in five-year breast cancer survival between Australia and England of 6% in the screening age group for women diagnosed during the period 1996-19991 One possible explanation: relatively low intensity of breast screening in England compared to Australia  Material Women aged 50 years or younger on 1st January 1996  Diagnosed with a primary invasive breast cancer during the period 1 January 1996 to 31 December 2006  5,717 women from West Midlands region of England   6,396 women New South Wales, Australia  All women were followed up to 31 December 2006                 Cancer registry data  Individual registry records linked to individual screening records  Categories for screening status at diagnosis: screen-detected, interval cancer, lapsed attender, non-attender Conclusions Survival remains higher in New South Wales compared to the West Midlands for women aged 50-64  Survival differences less marked for women who have attended screening Non-significant difference in survival amongst screen–detected women after adjustment for lead time Figure 4: Net survival estimates by screening category a) West Midlands     b) New South Wales Figure 1 – title Methods Non-parametric net survival estimates using the Pohar-Perme estimator2, using stns (software available for Stata 123)  Comparison of the Pohar-Perme estimates with widely used Estève approach4;5 Excess hazard and hazard ratios derived from survival Expected survival from regional life tables (single years of age for each year of follow-up) Adjustment for the potential effect of lead time bias: • calculation of adjusted survival time E(s) 6  • mean sojourn time of 4 years  • 10 simulated data sets: E(s)1, E(s)2 … E(s)10 assuming survival exponentially distributed with a mean of E(s) • survival estimates derived from these 10 separate data sets recombined using rules from the multiple-imputation setting7     Figure 1 – Cohort included in analyses References (1) Woods LM, Rachet B, O'Connell D, Lawrence G, Tracey E, Willmore A, Coleman MP. Large differences in patterns of breast cancer survival between Australia and England: a comparative study using cancer registry data. Int J Cancer 2009 May 15;124(10):2391-9. (2) Pohar-Perme M, Stare J, Estève J. On Estimation in Relative Survival. Biometrics 2011;DOI: 10.1111/j.1541-0420.2011.01640.x (3) STATA statistical software [computer program]. Version 12.1. College Station, Texas: Stata Corporation; 2006. (4) Estève J, Benhamou E, Croasdale M, Raymond L. Relative survival and the estimation of net survival: elements for further discussion. Statistics in Medicine 1990;9:529-38. (5) Cancer Research UK Cancer Survival Group. strel computer program version 5.8 and life tables for cancer survival analysis. Non-communicable Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, UK. Last update 19 November 2006. (6) Duffy SW, Nagtegaal ID, Wallis M, Cafferty FH, Houssami N, Warwick J, Allgood PC, Kearins O, Tappenden N, O'Sullivan E, Lawrence G. Correcting for lead time and length bias in estimating the effect of screen detection on cancer survival. Am J Epidemiol 2008 Jul 1;168(1):98-104. (7) Rubin DB. Multiple imputation for non-response in surveys. New York: John Wiley & Sons, 1987.  707580859095100Net survival estimate %0 1 2 3 4 5 6 7 8 9 10Years since diagnosisScreen-detected cancersCancers in lapsed attendersInterval cancersNever-attenders707580859095100Net survival estimate %0 1 2 3 4 5 6 7 8 9 10Years since diagnosisScreen-detected cancersCancers in lapsed attendersInterval cancersNever-attendersFigure 2: Net survival estimates:  Figure 3: Net survival estimates: West Midlands and New South Wales  Screen-detected vs. non-screened Study periodCancer diagnosisCancer diagnosisCancer diagnosisPatient 3: included (survival time censored at 31stDec 2006)Patient 2: included50th BirthdayDeath50th BirthdayDeath01/01/200701/01/200850th BirthdayDeathPatient 1: excluded                          (birthday prior to 1stJan 2006)01/01/200201/01/200301/01/200401/01/200501/01/200601/01/199501/01/199601/01/199701/01/199801/01/199901/01/200001/01/2001Figure 5: Estimates adjusted for   Figure 6: Adjusted net survival lead time bias: West Midlands   estimates: screen-detected cancers Differential survival in the non-screen detected groups may be due to women obtaining mammography privately in New South Wales Poorer treatment of non-screen detected women after their diagnosis remains one explanation for poorer survival in West Midlands  Figure 7: Excess hazard ratios comparing lead-time adjusted hazard in screened  group with the non-screened group   

The impact of screen-detection upon international differences in survival from breast cancer: a comparison of the West Midlands, England, and New South Wales, Australia (poster presentation)

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The impact of screen-detection upon international differences in survival from breast cancer: a comparison of the West Midlands, England, and New South Wales, Australia (poster presentation)

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