Checking lymph nodes during surgery and assessing the hormone status of tumours could help improve breast cancer survival in the UK, according to research published today in Annals of Oncology.
In a study of over 9,000 breast cancer patients* at 10 hospitals in the East of England researchers found that hospitals with a better average survival were those where surgeons checked lymph nodes during surgery in more than 90 per cent of patients.
Professor Stephen Duffy, Cancer Research UK professor of screening and study author, said: “We found that the proportion of women under 70 who had lymph node checks as recommended by NICE ranged from 81 per cent to 94 per cent with the hospitals with higher percentages having better survival.”
The study also found that, for women over 70, having surgery to remove their tumour and checking the hormone type were the two main factors which explained survival differences between hospitals.
The hospitals showing better survival in the over 70s were those which assessed the hormone receptor status in more of their patients.
The team of researchers** from London and Cambridge compared breast cancer survival rates between 10 different hospitals across eastern England.
For women under 70 the five year relative survival rates ranged from 85 to 90 per cent. And for those over 70 the survival rate was between 65 and 75 per cent.***
The figures are close to the highest rates in Europe**** but the researchers believe that survival could be even better if all hospitals closely followed the existing surgical guidelines.
Professor Duffy continued: “Although survival rates for breast cancer are very good in hospitals we studied in the East of England, rivalling the best in Europe, we have found that there is still room for improvement.
“One reason why survival varied between the hospitals for women under 70 was whether they had their lymph nodes removed and examined. Another is screening as we know from previous studies that women have a much better chance of survival if their tumour is picked up at an early stage. We would encourage all women to attend screening when invited.”
The researchers also found that more women older than 70 are surviving the disease if they have surgery. Another important factor for this group of women was whether the cancer’s hormone type was assessed at diagnosis. The researchers believe that with more hospitals following the guidelines on hormone receptor typing, there would be further improvements in survival.
Professor Gordon Wishart, the leading author on the study said: “Lymph node staging and hormone receptor typing give valuable information to decide on optimal treatment after surgery. As more hospitals follow current professional guidelines and carry out these investigations, more effective treatment will follow and patient survival is likely to improve even further.”
Professor Peter Johnson, Cancer Research UK’s chief clinician, said: “It’s very encouraging to see that at their best, results from the UK are the equal of those in Europe. The real challenge is to make sure that consistently high standards are met in all hospitals, so that every patient can benefit from the significant improvements in survival we have made.”
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Wishart, G., Greenberg, D., Chou, P., Brown, C., Duffy, S., & Purushotham, A. (2009). Treatment and survival in breast cancer in the Eastern Region of England Annals of Oncology DOI: 10.1093/annonc/mdp301
*All women had been diagnosed with breast cancer between 1999 and 2003.
**The team of researchers included Dr Clement Brown of the Eastern Cancer Registration and Information Centre and Professor Gordon Wishart, the lead author on the study.
***These figures are relative survival rates calculated from overall rates in the paper.
****Figures compared to the Eurocare study Comparative cancer survival information in Europe. Eur J Cancer. 2009 Apr;45(6):901-8.