Provision Of Breast Cancer Care And Survival In Germany Results From A Population-Based High Resolution Study From Saarland

Bernd HOLLECZEK, Saarland Cancer Registry, Germany
BRENNER H. 1,2,3

1 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
2 Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelber, Germany
3 German Cancer Consortium (DKTK), Heidelberg, Germany

Provision of breast cancer care and survival in Germany – results from a population-based high resolution study from Saarland

Purpose:Studies on the implementation of Clinical Practice Guidelines (CPG) and its effect on breast cancer (BRC) survival on a population-level are scant. This study provides data on the usage of BRC treatment, the extent of adherence to CPG and, as novelty, survival of BRC patients according to major recommended treatment options.
Methods: Data from the Saarland Cancer Registry including women diagnosed with invasive BRC without distant metastasis and follow up in 2000-2009 were used. Provision of treatment according to CPG  is presented by age, BRC type, and over time. Period analysis was used to derive estimates of 5-year relative survival (RS) and the effect of non-adherence to CPG on relative excess risk of death (RER).
Results: The study revealed increasing guideline adherence, with high levels already seen for local treatment (e.g. 67% of the patients in 2008/09 received breast conserving surgery), and substantial progress over time with regard to sentinel node dissection (SND) and adjuvant systemic treatment (e.g. SND and chemotherapy was provided to 62% of all patients and 79% of the patients with N+ or hormone receptor negative BRC in 2008/09, respectively). It further demonstrated increased cancer related mortality among patients without guideline compliant cancer treatment (e.g. patients with N+ and hormone receptor negative BRC without chemotherapy had a 5-year RS of 29% compared to 54% for patients receiving chemotherapy (RER: 2.89, 95% CI: 1.46–5.71)).
Conclusions: This study provides data on the implementation of CPG in Germany, extends available survival data of BRC patients and may provide evidence of increased cancer related excess mortality, if BRC patients do not receive guideline compatible treatment.
Funding source: None