FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 330:805-810 March 24, 1994 Number 12 Next

	Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods We examined the effect of adjuvant systemic therapy on survival after breast cancer among the residents of the Canadian province of British Columbia. Data on survival were collected for all women in whom breast cancer was diagnosed in British Columbia during each of three calendar years chosen to represent different province-wide treatment recommendations: 1974, when no adjuvant systemic therapy was recommended; 1980, when adjuvant chemotherapy was recommended only for premenopausal women with node-positive disease; and 1984, when adjuvant chemotherapy was also recommended for premenopausal women with node-negative disease and lymphatic, vascular, or neural invasion and tamoxifen was recommended for postmenopausal women with involved lymph nodes or lymphatic, vascular, or neural invasion unless their tumors were negative for estrogen receptors.

Results For women less than 50 years of age, disease-specific survival at seven years (i.e., with censoring of data on women who died from causes other than breast cancer) improved from 65.2 to 76.3 percent between 1974 and 1984 (P = 0.008), and overall survival improved from 64.8 to 74.6 percent (P = 0.02). For women from 50 through 89 years of age, disease-specific survival at seven years improved from 62.5 to 70.4 percent between 1980 and 1984 (P = 0.001), and overall survival improved from 53.9 to 58.3 percent (P = 0.05). The timing of the improvements in survival correlated with the introduction of adjuvant systemic therapy in each group.

Conclusions Survival among women with breast cancer improved significantly in a geographically defined population during the period when adjuvant systemic therapy became widely used.

Source Information

From the Divisions of Radiation Oncology (I.A.O., S.M.J.), Epidemiology (C.D.B.), Medical Oncology (I.H.P., C.M.C., K.A.G., J.R.), and Laboratory Medicine (A.W.), British Columbia Cancer Agency and the University of British Columbia, Vancouver; and the Division of Medical Oncology, British Columbia Cancer Agency, Victoria, British Columbia (K.S.W.) -- both in Canada.

Address reprint requests to Dr. Olivotto at the British Columbia Cancer Agency, 600 W. 10th Ave., Vancouver, BC V5Z 4E6, Canada.

Full Text of this Article

Related Letters:

Adjuvant Systemic Therapy and Survival after Breast Cancer
Sankaranarayanan R., Black R. J., Evans R. A., Olivotto I.A., Bajdik C.D., Coppin C.M.
Extract | Full Text  
N Engl J Med 1994; 331:402-404, Aug 11, 1994. Correspondence

This article has been cited by other articles:

• Jacobson, J. O. (2008). The Quality Oncology Practice Initiative (QOPI): An Important Tool for Measuring Quality and Improving Care. Am Soc Clin Oncol Ed Book 2008: 501-505 [Abstract] [Full Text]  
• Banerjee, M., George, J., Song, E. Y., Roy, A., Hryniuk, W. (2004). Tree-Based Model for Breast Cancer Prognostication. JCO 22: 2567-2575 [Abstract] [Full Text]  
• Weiss, R. B., Woolf, S. H., Demakos, E., Holland, J. F., Berry, D. A., Falkson, G., Cirrincione, C. T., Robbins, A., Bothun, S., Henderson, I. C., Norton, L. (2003). Natural History of More Than 20 Years of Node-Positive Primary Breast Carcinoma Treated With Cyclophosphamide, Methotrexate, and Fluorouracil-Based Adjuvant Chemotherapy: A Study by the Cancer and Leukemia Group B. JCO 21: 1825-1835 [Abstract] [Full Text]  
• Smith, T. J., Hillner, B. E. (2001). Ensuring Quality Cancer Care by the Use of Clinical Practice Guidelines and Critical Pathways. JCO 19: 2886-2897 [Abstract] [Full Text]  
• Hillner, B. E., Smith, T. J. (1998). Hospital Volume and Patient Outcomes in Major Cancer Surgery: A Catalyst for Quality Assessment and Concentration of Cancer Services. JAMA 280: 1783-1785 [Full Text]  
• (1998). Integrating Economic Analysis Into Cancer Clinical Trials: the National Cancer Institute-American Society of Clinical Oncology Economics Workbook. J Natl Cancer Inst Monogr 1998: 1-28 [Full Text]  
• Gillis, C. R, Hole, D. J (1996). Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland. BMJ 312: 145-148 [Abstract] [Full Text]  
• Sankaranarayanan, R., Black, R. J., Evans, R. A., Olivotto, I.A., Bajdik, C.D., Coppin, C.M. (1994). Adjuvant Systemic Therapy and Survival after Breast Cancer. NEJM 331: 402-404 [Full Text]