Differences in stage and treatment of breast cancer across Italy point to inequalities in access to and availability of proper care.
OBJECTIVE
Population-based cancer registry studies of patterns of care can help elucidate reasons for differences in breast cancer survival across Italy documented by previous studies. The aims of the present study were to investigate across-country variation in stage at presentation and standard care for breast cancer cases diagnosed in Italy in the early 2000s.


METHODS
Samples of adult (≥ 15 years) women with breast cancer diagnosed in 2003-2005 were randomly selected in 9 Italian cancer registries. Logistic regression models were used to estimate the odds of receiving breast-conserving surgery plus radiotherapy (BCS + RT) in each cancer registry, age group, and disease stage category compared with the entire sample (reference); the z test was used to evaluate differences in proportions of stage at diagnosis, employment of chemotherapy in node-positive (N+) disease, and use of endocrine treatment in estrogen-receptor positive (ER+) and negative (ER-) tumors across Italy.


RESULTS
Stage at diagnosis was earlier in northern/central registries than in southern areas. Compared with the reference, the odds of receiving BCS + RT was significantly lower in Trapani, Sassari and Naples (southern Italy) after adjusting for age and stage at diagnosis. Among N+ patients, 73% received adjuvant chemotherapy (range, 51% [Biella, northern Italy] to 87% [Ragusa, southern Italy]). Eighty percent of ER+ cancers (range, 50% [Biella, northern Italy] to 97% [Ragusa, southern Italy]) and 18% of ER- cancers (range, 6% [Modena, northern Italy] to 28% [Umbria, central Italy]) were treated with hormonal therapy.


CONCLUSIONS
Disparities in stage distributions and conservative surgery in breast cancer persist across Italy. On a positive note, we found lower variations in the use of systemic treatment between Italian regions.
1Department of Preventive and Predictive Medicine, Analytical Epidemiology Unit, FondazioneIRCSS Istituto Nazionale dei Tumori, Milan, Italy. pamela.minicozzi@istitutotumori.mi.it
Pamela
P
Minicozzi
Claudia
C
Cirilli
Massimo
M
Federico
Riccardo
R
Capocaccia
Mario
M
Budroni
Pina
P
Candela
Fabio
F
Falcini
Mario
M
Fusco
Adriano
A
Giacomin
Francesco
F
La Rosa
Adele
A
Traina
Rosario
R
Tumino
Milena
M
Sant
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000737:chemistry / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D018714:Radiotherapy, Adjuvant; D011960:Receptors, Estrogen / Q000032:analysis; D012042:Registries; D012959:Socioeconomic Factors
D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D011960:Receptors, Estrogen