Trends in breast cancer during three decades in Denmark: Stage at diagnosis, surgical management and survival

Figures & data

Table I.  Treatment strategies in the three counties according to time period.

	1986	1996–1997	2002–2003
NJ	No Mammography screening	No Mammography screening	No Mammography screening
	No SLNB	No SLNB	No SLNB
Aarhus	No Mammography screening	No Mammography screening	No Mammography screening
	No SLNB	No SLNB	+ SLNB
Funen	No Mammography screening	+ Mammography screening	+ Mammography screening
	No SLNB	No SLNB	+ SLNB

Table II.  Basic patient characteristics according to county and time period.

	1986				1996–1997				2002–2003
	Funen	Aarhus	N J		Funen	Aarhus	N J		Funen	Aarhus	N J
N	172	181	135	p	463	507	354	p	527	599	447	p
Age (year) Median (range)	53.4 (28-70)	54.5 (31–70)	55.9 (29–70)	ns	55.2 (26–70)	54 (24–70)	55 (28–70)	ns	57 (28–70)	55 (21–70)	56 (28-70)	0.03
Tumor size Median (range)	20 (4–120)	20 (4–100)	20 (5–91)	ns	16 (1–80)	19 (1–130)	20 (1–120)	0.001	15 (1–150)	20 (1–100)	20 (1-120)	0.001
Nodes removed Median (range)	10 (0–32)	5 (0–18)	7 (2–19)	0.001	14 (0–40)	13 (0–40)	12 (0–38)	0.001	18* (0–40)	14* (0–35)	18* (0–47)	0.001
T-stage (UICC)				ns				0.004				0.001
T1	81 (48)	89 (50)	78 (58)		298 (65)	286 (57)	186 (53)		350 (68)	290 (52)	233 (54)
T2	67 (40)	71 (40)	48 (35)		140 (30)	177 (35)	152 (43)		140 (27)	242 (43)	177 (41)
T3	14 (8)	10 (6)	9 (7)		7 (2)	22 (4)	10 (3)		20 (4)	25 (4)	16 (4)
T4	7 (4)	7 (4)	0		15 (3)	17 (3)	5 (1)		3 (1)	1 (0)	5 (1)
N-stage				0.009				0.03				0.001
N neg	80 (47)	107 (61)	77 (57)		269 (58)	266 (52)	175 (49)		276 (52)	243 (41)	199 (45)
N pos	77 (45)	61 (34)	58 (43)		169 (37)	206 (41)	155 (44)		238 (45)	318 (53)	231 (51)
N x	15 (8)	9 (5)	0		25 (5)	35 (7)	24 (7)		13 (3)	38 (6)	17 (4)
Stage (UICC)				ns				0.001				0.001
I	54 (32)	65 (37)	53 (39)		204 (44)	182 (36)	118 (33)		224 (43)	166 (29)	126 (29)
II	88 (51)	91 (52)	71 (53)		220 (48)	251 (50)	196 (56)		265 (51)	364 (63)	277 (64)
III	16 (9)	11 (6)	8 (6)		13 (3)	27 (5)	10 (3)		23 (4)	26 (5)	19 (4)
IV	13 (8)	9 (5)	3 (2)		21 (5)	44 (9)	26 (7)		6 (1)	18 (1)	10 (2)
Surgery				0.002				0.001				0.001
mastectomy	130 (76)	158 (87)	120 (89)		280 (61)	343 (68)	291 (82)		307 (58)	243 (41)	125 (28)
lumpectomy	31 (18)	16 (9)	15 (11)		161 (35)	134 (27)	46 (13)		219 (42)	356 (59)	318 (71)
sentinel lymph node procedure									278 (53)	299 (50)	55 (12)	0.001
Histology				ns				ns				0.001
ductal	142 (83)	158 (87)	100 (74)		383 (83)	421 (83)	284 (80)		419 (79)	445 (75)	343 (77)
lobular	17 (10)	11 (6)	16 (12)		46 (10)	37 (7)	35 (10)		51 (10)	79 (14)	46 (11)
other	12 (7)	12 (7)	19 (14)		31 (7)	46 (9)	35 (10)		44 (8)	39 (7)	50 (11)
Malignancy grade				0.001				0.04				0.001
I	40 (25)	38 (22)	32 (24)		119 (27)	112 (23)	96 (29)		140 (27)	118 (21)	65 (15)
II	58 (36)	84 (49)	43 (33)		183 (41)	198 (41)	112 (33)		170 (33)	180 (32)	168 (39)
III	38 (24)	28 (16)	44 (33)		85 (9)	103 (21)	63 (9)		102 (20)	138 (25)	98 (23)
Non-ductal	26 (16)	21 (12)	32 (24)		56 (13)	70 (15)	65 (19)		95 (19)	118 (21)	96 (22)
Estrogen receptor								0.001				ns
Negative					97 (22)	165 (34)	105 (31)		93 (18)	124 (22)	92 (21)
positive					345 (78)	316 (66)	238 (69)		418 (82)	435 (78)	348 (79)

* Not including patients with sentinel lymph node biopsies. Estrogen receptor status was not routinely analysed in 1986. Percentages in parentheses.

Figure 1.  Estimate of Relative Survival proportion ratios by year of diagnosis and county. Thick line: Funen, Thin line: Aarhus, Dot line: Northern Jutland.

Table III.  Crude and relative survival according to year at diagnosis. 95% CI in parentheses.

	Crude over-all survival (%)			Relative survival (%)
Year of diagnosis	1986	1996–1997	2002–2003	1986	1996–1997	2002–2003
5 year	73.8 (70–78)	78.2 (76–80)	84.1 (82–86)	77.4 (73–81)	81.9 (80–84)	87.8 (86–90)
10 year	55.1 (51–60)	66.2 (64–69)		62.2 (57–67)	73.8 (71–77)
15 year	45.1 (41–49)			56.4 (51–65)
20 year	36.5 (32–41)			52.6 (47–59)

Table IV.  Multivariate Cox regression analysis of prognostic factors for death of all caurses. 95% confidence intervals in parentheses.

	1986		1996–1997		2002–2003		All Patients
	Hazard rate ratios	p	Hazard rate ratios	p	Hazard rate ratios	p	Hazard rate ratios	p
County		0.03		0.30		0.75		0.01
Funen	1		1		1		1
Aarhus	1.36 (1.0–1.8)	0.03	0.97 (0.8–1.2)	0.77	0.87 (0.6–1.2)	0.46	1.14 (1–0–1.3)	0.93
NJ	1.46 (1.1–2.0)	0.01	1.16 (0.9–1.5)	0.26	0.90 (0.6–1.3)	0.59	1.29 (1.1–1.5)	0.03
Age (year)		<0.001		<0.001		0.14		<0.001
< 40	1		1		1		1
40–49	0.73 (0.4–1.2)	0.22	0.65 (0.4–1.0)	0.05	1.30 (0.6–2.7)	0.48	0.77 (0.6–1.0)	0.09
50–59	0.97 (0.6–1.6)	0.89	0.74 (0.5–1.1)	0.15	1.83 (0.9–3.7)	0.09	0.92 (0.7–1.2)	0.54
> 59	1.52 (0.9–2.4)	0.78	1.27 (0.9–1.9)	0.24	1.80 (0.9–3.6)	0.10	1.30 (1.0–1.7)	0.05
T–stage		<0.001		<0.001		<0.001	0.31 (0.2–0.4)	<0.001
TI	1		1		1		1	<0.001
TII	1.54 (1.2–2.0)	<0.001	1.44 (1.2–1.8)	0.001	1.81 (1.3–2.5)	<0.001	1.63 (1.4–1.9)
TIII	2.64 (1.7–4.1)	<0.001	1.70 (1.1–2.7)	0.02	3.00 (1.8–5.1)	<0.001	2.33 (1.8–3.0)	<0.001
TIV	6.59 (1.9–2.3)	0.003	3.17 (1.7–6.0)	<0.001	6.16 (2.2–18)	<0.001	4.76 (3.0–7.5)	<0.001
N-stage		<0.001		<0.001		<0.001		<0.001
N-neg	1		1		1		1
N-pos	1.57 (1.2–2.0)	<0.001	2.36 (1.9–2.9)	<0.001	2.72 (1.9–3.9)	<0.001	2.04 (1.8–2.4)	<0.001
Nx	1.56 (0.5–4.9)	0.44	3.27 (2.0–5.3)	<0.001	3.54 (0.8–15)	<0.001	2.43 (1.6–3.6)	<0.001
M-stage		<0.001		<0.001		<0.001		<0.001
M0	1		1		1		1
MI	2.91 (1.7–5.1)		3.90 (2.8–5.6)		4.67 (2.2–9.8)		3.30 (2.5–4.3)
Malignacy grade		0.003		0.003		0.18		<0.001
I	1		1		1		1
II, III	1.57 (1.2–2.1)		1.51 (1.2–2.0)		1.41 (0.9–2.3)		1.73 (1.4–2.1)
Estrogen receptor				<0.001		<0.001
negative			1		1
positive			0.52 (0.4–0.6)		0.41 (0.3–0.6)
Sentinel lymph node biopsy						0.003
no					1
yes					0.58 (0.4–0.8)
Year at diagnosis								<0.001
1986							1
1996–97							0.71 (0.6–0.8)	<0.001
2002–03							0.50 (0.4–0.6)	<0.001

Table V.  Time trends for al counties and within each county.

	All Counties					Funen		Aarhus		NJ
	1986	1996–97	2002–03	86/96–97	96–97/02–03	86/96–97	96–97/02–03	86/96–97	96–97/02–03	86/96–97	96–97/02–03
	488	1324	1573	p	p	p	p	p	p	p	p
Age (year) Median (range)	54 (28–70)	54 (24–70)	56 (21–70)	ns	ns	0.03	ns	ns	ns	ns	ns
Tumor size Median (range)	20 (4–120)	18 (1–130)	19 (1–150)	0.001	0.06	0.001	ns	0.01	0.02	ns	ns
Nodes removed Median (range)	7 (0–32)	13 (0–40)	16* (0–47)	0.001	0.001	0.001	0.001	0.001	0.009	0.001	0.001
T–stage (UICC)				0.003	ns	0.001	ns	ns	ns	ns	ns
T1	250 (52)	770 (59)	873 (58)
T2	188 (39)	469 (36)	559 (37)
T3	33 (7)	39 (3)	61 (4)
T4	14 (3)	37 (3)	9 (1)
N-stage				ns	0.001	0.007	0.03	0.05	0.001	0.04	ns
N neg	267 (55)	710 (54)	718 (46)
N pos	197 (40)	530 (40)	787 (50)
N x	24 (5)	84 (6)	68 (4)
Stage (UICC)				ns	ns	0.001	ns	ns	ns	ns	ns
I	174 (36)	504 (38)	516 (34)
II	252 (52)	667 (51)	906 (59)
III	37 (7)	50 (4)	68 (5)
IV	25 (5)	91 (7)	34 (2)
Surgery				0.001	0.001	0.001	ns	0.001	0.001	0.05	0.001
Mastectomy	408 (84)	914 (69)	675 (43)
Lumpectomy	62 (13)	341 (26)	893 (57)
Histology				ns	0.001	ns	ns	ns	0.001	ns	ns
Ductal	400 (82)	1088 (82)	1207 (77)
Lobular	44 (9)	118 (9)	176 (11)
Other	43 (9)	112 (9)	133 (9)
Malignancy grade				0.001	0.01	ns	ns	ns	ns	ns	0.001
I	121 (26)	327 (26)	323 (22)
II	186 (40)	493 (39)	518 (34)
III	79 (17)	251 (20)	338 (22)
Non-ductal	79 (17)	191 (15)	309 (21)
Estrogen receptor					0.001		ns		0.001		0.001
Negative		367 (29)	309 (20)
Positive		899 (71)	1201 (80)

*Not including patients with sentinel lymph node biopsies. Estrogen receptor status was not routinely analysed in 1986. Percentages in parentheses.

Figure 2.  Estimates of relative survival proportion ratios by year of diagnosis.