U.S. Women Likelier to Survive Breast Cancer

Study comparing rates to European counterparts finds early detection is key

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By
HealthDay Reporter

MONDAY, Dec. 29, 2003 (HealthDayNews) -- Detecting and treating breast cancer early appears to be the reason that U.S. women have significantly greater five-year survival rates than women in Europe -- 89 percent vs. 79 percent.

"Breast cancer is diagnosed at earlier stages in the U.S. than in Europe, and this is the reason for the higher survival found by previous studies," says lead researcher Dr. Milena Sant, an epidemiologist from the National Institute for the Study and the Cure of the Tumors in Milan, Italy.

Sant's team looked at population-based data from 4,478 women with breast cancer from six countries included in the EUROCARE study: Estonia, France, Italy, Spain, The Netherlands and the United Kingdom.

The researchers compared these women with 13,172 similar American women from the Surveillance, Epidemiology, End Results (SEER) program. The SEER program is part of the National Cancer Institute, which measures cancer rates in the United States.

The data Sant's group used were from 1991 to 1992, when the SEER study covered only 10 percent of the U.S. population, and the EUROCARE study covered only 14 percent of the populations in the participating countries, according to the report in the Feb. 15 issue of Cancer.

An examination of the data revealed that in Europe early-stage tumors were reported in only 29 percent of the cases, while in the United States early-stage tumors were reported in 41 percent of cases.

In addition, U.S. women aged 65 and older had early-stage disease reported more often than did younger women (43 percent vs. 38 percent). In Europe, meanwhile, early-stage disease was reported in only 25 percent of older women and in 31 percent of younger women, the researchers found.

Moreover, while most American and European women had surgery, older European women tended to have tumors that were significantly larger than those of older U.S. women.

Sant's team also found the five-year survival rate in the United States was 89 percent compared with 79 percent in Europe. "Differences in therapy seem not to affect this difference in survival," she says. "After diagnosis, patients seem to be treated similarly in Europe and the U.S."

Sant notes that some of the differences in survival could be related to selection of patients. Data from Europe did not include the countries with highest survival rates, namely Sweden, Norway and Finland, she adds.

Given these data, Sant believes that "in Europe more resources should be allocated to appropriate diagnostic facilities, especially in those countries with a high proportion of advanced tumor stage at diagnosis."

"Early diagnosis and prompt referral should be encouraged, as should screening programs," she adds.

Dr. David Spiegel, a professor of psychiatry and behavioral sciences at Stanford University, says, "I am surprised to see this much of a difference. I don't think we have a notably better health-care system here."

Spiegel believes Americans have a more optimistic outlook on life then Europeans, and this might translate into a belief in the value of early detection and screening seen in the United States. "And early screening can make a difference in mortality," he says.

"This study clearly shows that Europeans should devote resources to increasing the rate of breast cancer screening, and Americans should sustain their investments in this area," says Dr. David Katz, an associate clinical professor of public health at Yale University.

He adds physicians should advise their patients of the importance of mammography. They should also continue to screen older women with a relatively long life expectancy, "and work to improve the clarity and interpretation of mammograms for even better outcomes."

"Patients should line up for this lifesaving test," Katz says. "We have the technology to find breast cancer early, and data to show that early detection saves lives."

More information

To learn more about breast cancer detection, visit the National Cancer Institute. Get a primer on the disease from the American Cancer Society.

SOURCES: Milena Sant, M.D., epidemiologist, National Institute for the Study and the Cure of the Tumors, Milan, Italy; David Spiegel, M.D., professor, psychiatry and behavioral sciences, Stanford University, Palo Alto, Calif.; David Katz, M.D., M.P.H., associate clinical professor, public health, Yale University, New Haven, Conn.; Feb. 15, 2004, Cancer

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