title: Overall survival from breast cancer in Kerala, India, in relation to menstrual, reproductive, and clinical factors.
abstract: BACKGROUND
  Breast cancer accounts for one-fourth of cancer cases seen in female patients in Kerala, India. Results of a retrospective analysis of breast cancer in Kerala are presented in this article.
  
  
  METHODS
  Case records of 449 patients with breast carcinoma treated during 1983-1984 were reviewed. Survival analysis was done by the Kaplan-Meier product limit method. The survival curves were compared by the log-rank test. A forward stepwise procedure with the Cox proportional hazards regression analysis was performed to identify factors influencing survival.
  
  
  RESULTS
  The overall 5-year survival rate was 40%. The 5-year survival rates were 85% for patients with T1, 63% for T2, 32% for T3, and 21% for T4 lesions. Those with N0 disease had a 68% 5-year survival rate. The survival rates were 90% for patients with Stage I, 65% for Stage II, 33% for Stage III, and 6% for Stage IV disease. On multivariate analysis, the following factors were found to significantly influence survival: response to treatment (P < 0.001), stage (P < 0.01), and regional nodal involvement (P < 0.05).
  
  
  CONCLUSIONS
  Two-thirds of patients with advanced-stage disease on presentation seem to account for the poor overall survival. Early detection of breast cancer by breast self-examination and physician breast examination should be encouraged in developing countries to improve treatment results in breast cancer.
authors.affiliation: Regional Cancer Centre, Trivandrum, India.
authors.forename: M K
authors.initials: MK
authors.lastname: Nair
authors.forename: R
authors.initials: R
authors.lastname: Sankaranarayanan
authors.forename: K S
authors.initials: KS
authors.lastname: Nair
authors.forename: N S
authors.initials: NS
authors.lastname: Amma
authors.forename: C
authors.initials: C
authors.lastname: Varghese
authors.forename: G
authors.initials: G
authors.lastname: Padmakumari
authors.forename: T
authors.initials: T
authors.lastname: Cherian
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D016504:Breast Self-Examination; D005260:Female; D006801:Humans; D007194:India; D008598:Menstruation; D008875:Middle Aged; D009367:Neoplasm Staging; D010298:Parity; D012189:Retrospective Studies; D016019:Survival Analysis