• S Walters, C Maringe, J Butler, B Rachet, P Barrett-Lee, J Bergh, J Boyages, P Christiansen, M Lee, F Wärnberg, C Allemani, G Engholm, T Fornander, M L Gjerstorff, T B Johannesen, G Lawrence, C E McGahan, R Middleton, J Steward, E Tracey, D Turner, M A Richards, M P Coleman, and ICBP Module 1 Working Group.
• Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK. sarah.walters@lshtm.ac.uk
• Br. J. Cancer. 2013 Mar 19; 108 (5): 1195-208.

BackgroundWe investigate whether differences in breast cancer survival in six high-income countries can be explained by differences in stage at diagnosis using routine data from population-based cancer registries.MethodsWe analysed the data on 257,362 women diagnosed with breast cancer during 2000-7 and registered in 13 population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK. Flexible parametric hazard models were used to estimate net survival and the excess hazard of dying from breast cancer up to 3 years after diagnosis.ResultsAge-standardised 3-year net survival was 87-89% in the UK and Denmark, and 91-94% in the other four countries. Stage at diagnosis was relatively advanced in Denmark: only 30% of women had Tumour, Nodes, Metastasis (TNM) stage I disease, compared with 42-45% elsewhere. Women in the UK had low survival for TNM stage III-IV disease compared with other countries.ConclusionInternational differences in breast cancer survival are partly explained by differences in stage at diagnosis, and partly by differences in stage-specific survival. Low overall survival arises if the stage distribution is adverse (e.g. Denmark) but stage-specific survival is normal; or if the stage distribution is typical but stage-specific survival is low (e.g. UK). International differences in staging diagnostics and stage-specific cancer therapies should be investigated.

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