Monitoring TNM stage of female breast cancer and survival across the South Australian population, with national and international TNM benchmarking: A population-based cohort study

Ming Li; David Roder; Katina D'Onise; David Walters; Gelareh Farshid; Elizabeth Buckley; Chris Karapetis; Rohit Joshi; Timothy Price; Amanda Townsend; Caroline Louise Miller; David Currow; Kate Powell; Dianne Buranyi-Trevarton; Ian Olver

doi:10.1136/bmjopen-2020-037069

Monitoring TNM stage of female breast cancer and survival across the South Australian population, with national and international TNM benchmarking: A population-based cohort study

Ming Li, David Roder, Katina D'Onise, David Walters, Gelareh Farshid, Elizabeth Buckley, Chris Karapetis, Rohit Joshi, Timothy Price, Amanda Townsend, Caroline Louise Miller, David Currow, Kate Powell, Dianne Buranyi-Trevarton, Ian Olver

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Abstract

OBJECTIVE: Using linked cancer registry and administrative data to monitor, tumour, node and metastases (TNM) stage and survival from female breast cancer in Australia. METHOD: Analysis of 2000-2014 diagnoses with linked population-based data to investigate: (1) sociodemographic predictors of advanced stage (stages III and IV), using unadjusted and adjusted logistic regression; and (2) sociodemographic factors and stage as predictors of breast cancer survival using competing risk regression. DESIGN: Population-based registry cohort. SETTING AND PARTICIPANTS: 14 759 South Australian women diagnosed in 2000-2014. PRIMARY AND SECONDARY OUTCOME MEASURES: Stage and survival. RESULTS: At diagnosis, 46% of women were classified as stage I, 39% as stage II, 12% as stage III and 4% as stage IV. After adjusting for sociodemographic factors, advanced stage was more common: (1) for ages <50 years; and although not statistically significant, for ages 80+ years; and (2) in women from socioeconomically disadvantaged areas. Compared with 2000-2004 diagnoses, stage and sociodemographic adjusted risks (sub-HRs (SHRs)) of breast cancer death were lower in 2005-2009 (SHR 0.75, 95% CI 0.67 to 0.83) and 2010-2015 (SHR 0.57, 95% CI 0.48 to 0.67). Compared with stage I, the SHR was 3.87 (95% CI 3.32 to 4.53) for stage II, 10.87 (95% CI 9.22 to 12.81) for stage III, and 41.97 (95% CI 34.78 to 50.65) for stage IV. Women aged 70+ years at diagnosis and those living in the most socioeconomically disadvantaged areas were at elevated risk of breast cancer death, independent of stage and sociodemographic factors. CONCLUSIONS: Stage varied by age, diagnostic period and socioeconomic status, and was a stronger predictor of survival than other statistically significant sociodemographic predictors. Achieving earlier diagnosis outside the original BreastScreen target of 50-69 years (as applying <2014) and in residents of socioeconomically disadvantaged areas likely would increase cancer survival at a population level.

Original language	English
Article number	e037069
Pages (from-to)	e037069
Journal	BMJ Open
Volume	10
Issue number	6
DOIs	https://doi.org/10.1136/bmjopen-2020-037069
Publication status	Published - Jun 2020

Bibliographical note

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Keywords

breast tumours
epidemiology
public health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Li, M., Roder, D., D'Onise, K., Walters, D., Farshid, G., Buckley, E., Karapetis, C., Joshi, R., Price, T., Townsend, A., Miller, C. L., Currow, D., Powell, K., Buranyi-Trevarton, D., & Olver, I. (2020). Monitoring TNM stage of female breast cancer and survival across the South Australian population, with national and international TNM benchmarking: A population-based cohort study. BMJ Open, 10(6), e037069. Article e037069. https://doi.org/10.1136/bmjopen-2020-037069

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title = "Monitoring TNM stage of female breast cancer and survival across the South Australian population, with national and international TNM benchmarking: A population-based cohort study",

abstract = "OBJECTIVE: Using linked cancer registry and administrative data to monitor, tumour, node and metastases (TNM) stage and survival from female breast cancer in Australia. METHOD: Analysis of 2000-2014 diagnoses with linked population-based data to investigate: (1) sociodemographic predictors of advanced stage (stages III and IV), using unadjusted and adjusted logistic regression; and (2) sociodemographic factors and stage as predictors of breast cancer survival using competing risk regression. DESIGN: Population-based registry cohort. SETTING AND PARTICIPANTS: 14 759 South Australian women diagnosed in 2000-2014. PRIMARY AND SECONDARY OUTCOME MEASURES: Stage and survival. RESULTS: At diagnosis, 46% of women were classified as stage I, 39% as stage II, 12% as stage III and 4% as stage IV. After adjusting for sociodemographic factors, advanced stage was more common: (1) for ages <50 years; and although not statistically significant, for ages 80+ years; and (2) in women from socioeconomically disadvantaged areas. Compared with 2000-2004 diagnoses, stage and sociodemographic adjusted risks (sub-HRs (SHRs)) of breast cancer death were lower in 2005-2009 (SHR 0.75, 95% CI 0.67 to 0.83) and 2010-2015 (SHR 0.57, 95% CI 0.48 to 0.67). Compared with stage I, the SHR was 3.87 (95% CI 3.32 to 4.53) for stage II, 10.87 (95% CI 9.22 to 12.81) for stage III, and 41.97 (95% CI 34.78 to 50.65) for stage IV. Women aged 70+ years at diagnosis and those living in the most socioeconomically disadvantaged areas were at elevated risk of breast cancer death, independent of stage and sociodemographic factors. CONCLUSIONS: Stage varied by age, diagnostic period and socioeconomic status, and was a stronger predictor of survival than other statistically significant sociodemographic predictors. Achieving earlier diagnosis outside the original BreastScreen target of 50-69 years (as applying <2014) and in residents of socioeconomically disadvantaged areas likely would increase cancer survival at a population level.",

keywords = "breast tumours, epidemiology, public health",

author = "Ming Li and David Roder and Katina D'Onise and David Walters and Gelareh Farshid and Elizabeth Buckley and Chris Karapetis and Rohit Joshi and Timothy Price and Amanda Townsend and Miller, {Caroline Louise} and David Currow and Kate Powell and Dianne Buranyi-Trevarton and Ian Olver",

note = "This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.",

year = "2020",

month = jun,

doi = "10.1136/bmjopen-2020-037069",

language = "English",

volume = "10",

pages = "e037069",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "group.bmj.com",

number = "6",

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Li, M, Roder, D, D'Onise, K, Walters, D, Farshid, G, Buckley, E, Karapetis, C, Joshi, R, Price, T, Townsend, A, Miller, CL, Currow, D, Powell, K, Buranyi-Trevarton, D & Olver, I 2020, 'Monitoring TNM stage of female breast cancer and survival across the South Australian population, with national and international TNM benchmarking: A population-based cohort study', BMJ Open, vol. 10, no. 6, e037069, pp. e037069. https://doi.org/10.1136/bmjopen-2020-037069

TY - JOUR

T1 - Monitoring TNM stage of female breast cancer and survival across the South Australian population, with national and international TNM benchmarking

T2 - A population-based cohort study

AU - Li, Ming

AU - Roder, David

AU - D'Onise, Katina

AU - Walters, David

AU - Farshid, Gelareh

AU - Buckley, Elizabeth

AU - Karapetis, Chris

AU - Joshi, Rohit

AU - Price, Timothy

AU - Townsend, Amanda

AU - Miller, Caroline Louise

AU - Currow, David

AU - Powell, Kate

AU - Buranyi-Trevarton, Dianne

AU - Olver, Ian

N1 - This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

PY - 2020/6

Y1 - 2020/6

N2 - OBJECTIVE: Using linked cancer registry and administrative data to monitor, tumour, node and metastases (TNM) stage and survival from female breast cancer in Australia. METHOD: Analysis of 2000-2014 diagnoses with linked population-based data to investigate: (1) sociodemographic predictors of advanced stage (stages III and IV), using unadjusted and adjusted logistic regression; and (2) sociodemographic factors and stage as predictors of breast cancer survival using competing risk regression. DESIGN: Population-based registry cohort. SETTING AND PARTICIPANTS: 14 759 South Australian women diagnosed in 2000-2014. PRIMARY AND SECONDARY OUTCOME MEASURES: Stage and survival. RESULTS: At diagnosis, 46% of women were classified as stage I, 39% as stage II, 12% as stage III and 4% as stage IV. After adjusting for sociodemographic factors, advanced stage was more common: (1) for ages <50 years; and although not statistically significant, for ages 80+ years; and (2) in women from socioeconomically disadvantaged areas. Compared with 2000-2004 diagnoses, stage and sociodemographic adjusted risks (sub-HRs (SHRs)) of breast cancer death were lower in 2005-2009 (SHR 0.75, 95% CI 0.67 to 0.83) and 2010-2015 (SHR 0.57, 95% CI 0.48 to 0.67). Compared with stage I, the SHR was 3.87 (95% CI 3.32 to 4.53) for stage II, 10.87 (95% CI 9.22 to 12.81) for stage III, and 41.97 (95% CI 34.78 to 50.65) for stage IV. Women aged 70+ years at diagnosis and those living in the most socioeconomically disadvantaged areas were at elevated risk of breast cancer death, independent of stage and sociodemographic factors. CONCLUSIONS: Stage varied by age, diagnostic period and socioeconomic status, and was a stronger predictor of survival than other statistically significant sociodemographic predictors. Achieving earlier diagnosis outside the original BreastScreen target of 50-69 years (as applying <2014) and in residents of socioeconomically disadvantaged areas likely would increase cancer survival at a population level.

AB - OBJECTIVE: Using linked cancer registry and administrative data to monitor, tumour, node and metastases (TNM) stage and survival from female breast cancer in Australia. METHOD: Analysis of 2000-2014 diagnoses with linked population-based data to investigate: (1) sociodemographic predictors of advanced stage (stages III and IV), using unadjusted and adjusted logistic regression; and (2) sociodemographic factors and stage as predictors of breast cancer survival using competing risk regression. DESIGN: Population-based registry cohort. SETTING AND PARTICIPANTS: 14 759 South Australian women diagnosed in 2000-2014. PRIMARY AND SECONDARY OUTCOME MEASURES: Stage and survival. RESULTS: At diagnosis, 46% of women were classified as stage I, 39% as stage II, 12% as stage III and 4% as stage IV. After adjusting for sociodemographic factors, advanced stage was more common: (1) for ages <50 years; and although not statistically significant, for ages 80+ years; and (2) in women from socioeconomically disadvantaged areas. Compared with 2000-2004 diagnoses, stage and sociodemographic adjusted risks (sub-HRs (SHRs)) of breast cancer death were lower in 2005-2009 (SHR 0.75, 95% CI 0.67 to 0.83) and 2010-2015 (SHR 0.57, 95% CI 0.48 to 0.67). Compared with stage I, the SHR was 3.87 (95% CI 3.32 to 4.53) for stage II, 10.87 (95% CI 9.22 to 12.81) for stage III, and 41.97 (95% CI 34.78 to 50.65) for stage IV. Women aged 70+ years at diagnosis and those living in the most socioeconomically disadvantaged areas were at elevated risk of breast cancer death, independent of stage and sociodemographic factors. CONCLUSIONS: Stage varied by age, diagnostic period and socioeconomic status, and was a stronger predictor of survival than other statistically significant sociodemographic predictors. Achieving earlier diagnosis outside the original BreastScreen target of 50-69 years (as applying <2014) and in residents of socioeconomically disadvantaged areas likely would increase cancer survival at a population level.

KW - breast tumours

KW - epidemiology

KW - public health

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U2 - 10.1136/bmjopen-2020-037069

DO - 10.1136/bmjopen-2020-037069

M3 - Article

C2 - 32595164

AN - SCOPUS:85087253710

SN - 2044-6055

VL - 10

SP - e037069

JO - BMJ Open

JF - BMJ Open

IS - 6

M1 - e037069

ER -

Monitoring TNM stage of female breast cancer and survival across the South Australian population, with national and international TNM benchmarking: A population-based cohort study

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Bibliographical note

Keywords

UN SDGs

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