title: Trends in patient characteristics, treatment and survival in breast cancer in a non-selected retrospective clinical cohort study of 2,600 patients.
abstract: OBJECTIVE
  Breast cancer epidemiology and survival recently saw major changes resulting from improved screening and treatment modalities. This paper aims to provide an overview of changes in recent years in patient characteristics and treatment procedures.
  
  
  METHODS
  Using data from BRENDA, an unselected cohort with universal coverage of a constant catchment area over a 13-year observation period, this study provides an overview of key trends.
  
  
  RESULTS
  Beside steady increases in overall and disease-free survival, main trends in recent years included a gradual increase in new patients' average ages. Grading, but not T stages, improved. Node negative, endocrine responsive patient shares increased; node positive, endocrine responsive shares decreased. HER2neu screening went from uncommon to ubiquitous. Sentinel node biopsy reduced excised numbers of lymph nodes. Second and third generation chemotherapies replaced CMF. Neoadjuvant therapy was gradually introduced. Aromatase inhibitors pushed down Tamoxifen use. 90 % of endocrine responsive patients now receive endocrine therapy. Our results suggest that improved survival only partially results from improved prognostic factors, but rather seems mainly due to improved treatment modalities.
  
  
  CONCLUSIONS
  Treatment procedures have changed dramatically over recent years. This was associated with steady increases in favorable outcomes among patients.
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Str. 69, 55131 Mainz, Germany. vanewijk@imbei.uni-mainz.de
authors.forename: R J G
authors.initials: RJ
authors.lastname: Van Ewijk
authors.forename: L
authors.initials: L
authors.lastname: Schwentner
authors.forename: A
authors.initials: A
authors.lastname: Wöckel
authors.forename: J
authors.initials: J
authors.lastname: König
authors.forename: R
authors.initials: R
authors.lastname: Kreienberg
authors.forename: M
authors.initials: M
authors.lastname: Blettner
mesh_terms: D000367:Age Factors; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008593:Menopause; D008875:Middle Aged; D011379:Prognosis; D011878:Radiotherapy; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D013514:Surgical Procedures, Operative; D015996:Survival Rate; D013629:Tamoxifen / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D004965:Estrogen Antagonists; D013629:Tamoxifen