title: Treatment and survival from breast cancer: the experience of patients at South Australian teaching hospitals between 1977 and 2003.
abstract: BACKGROUND
  Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guidelines.
  
  
  OBJECTIVE
  To use registry data to: (1) investigate trends in survival and treatment; and (2) compare treatment with guidelines.
  
  
  METHODS
  Registry data from three teaching hospitals were used to analyse trends in primary courses of treatment of breast cancers during 1977-2003 (n=4671), using univariate analyses and multiple logistic regression. Disease-specific survivals were analysed using Kaplan-Meier product limit estimates and multivariable Cox proportional hazards regression.
  
  
  RESULTS
  The 5-year survival was 79.9%, but with a secular increase, reaching 83.6% in 1997-2003. The relative risk of death (95% confidence limits) was 0.74 (0.62, 0.88) for 1997-2003, compared with previous diagnoses, after adjusting for tumour node metastasis stage, grade, age and place of residence. Treatment changes included an increase in conservative surgery (as opposed to mastectomy) from 51.7% in 1977-1990 to 76.8% in 1997-2003 for stage I (P<0.001) and from 31.1% to 52.2% across these periods for stage II (P<0.001). Adjuvant radiotherapy also became more common (P<0.001), with 20.6% of patients receiving this treatment in 1977-1990 compared with 60.7% in 1997-2003. Radiotherapy generally was more prevalent when conservative surgery was provided, although also relatively common in mastectomy patients when tumour diameters exceeded 50 mm or when there were four or more involved nodes. The proportion of patients receiving chemotherapy increased (P<0.001), from 19.6% in 1977-1990 to 36.9% in 1997-2003, and the proportion having hormone therapy also increased (P<0.001), from 34.3% to 59.4% between these periods.
  
  
  CONCLUSIONS
  Survivals appear to be increasing and treatment trends are broadly consistent with guideline directions, and the earlier research on which these recommendations were based.
authors: Epidemiology Branch, Department of Health, South Australian Government, Adelaide, SA, Australia.
authors: Colin
authors: C
authors: Luke
authors: Grantley
authors: G
authors: Gill
authors: Stephen
authors: S
authors: Birrell
authors: Vlad
authors: V
authors: Humeniuk
authors: Martin
authors: M
authors: Borg
authors: Christos
authors: C
authors: Karapetis
authors: Bogda
authors: B
authors: Koczwara
authors: Ian
authors: I
authors: Olver
authors: Michael
authors: M
authors: Penniment
authors: Ken
authors: K
authors: Pittman
authors: Tim
authors: T
authors: Price
authors: David
authors: D
authors: Walsh
authors: Eng Kiat Eric
authors: EK
authors: Yeoh
authors: David
authors: D
authors: Roder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008875:Middle Aged; D010361:Patients; D016016:Proportional Hazards Models; D012042:Registries; D013021:South Australia; D016019:Survival Analysis