Endocrine treatment and incidence of relapse in women with oestrogen receptor-positive breast cancer in Europe: a population-based study.

Milena Sant, Elisabetta Meneghini, Joana Bastos, Paolo Giorgi Rossi, Marcela Guevara, Kaire Innos, Alexander Katalinic, Leire Gil Majuelo, Rafael Marcos-Gragera, Florence Molinié, Elisabetta Rapiti, Ana Vizcaino, Vesna Zadnik, Pamela Minicozzi

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: Endocrine therapy (ET) is the mainstream adjuvant treatment for ER-positive breast cancer (BC). We analysed 9293 ER-positive BC patients diagnosed in nine European countries in 2009-2013 to investigate how comorbidities at diagnosis, age, stage and subtype affected ET use over time, and relapse. METHODS: Adjusted odds ratios (ORs) and 9595 of receiving ET were estimated according to Charlson comorbidity, age, stage and subtype using logistic regression. The 2-year cumulative incidence and adjusted sub-hazard ratios (SHRs) of relapse were estimated using competing risk analysis, with all-cause death as the competing event. The z-test was used to assess differences in the proportion of patients receiving ET in 1996-1998 and 2009-2013. RESULTS: Ninety percent of the patients started adjuvant ET, range 96Belgium, Estonia, Slovenia, Spain)-75Switzerland). ORs of starting ET were lower for women aged textgreater 75 years, with severe comorbidities, or luminal B HER2-positive cancer. The factors independently increasing the risk of relapse were: not receiving ET (SHR 2.26, 95.02-5.03); severe comorbidity (SHR 1.94, 95.06-3.55); luminal B, either HER2 negative (SHR 3.06, 95.61-5.79) or positive (SHR 3.10, 95.36-7.07); stage II (SHR 3.20, 95.56-6.57) or stage III (SHR 7.41, 95.48-15.73). ET use increased significantly but differently across countries from 51-85996-1998 to 86-96009-2013. CONCLUSIONS: ER-positive BC patients in Europe are increasingly prescribed ET but between-country disparities persist. Older women and women with severe comorbidity less frequently receive ET. ET omission and severe comorbidity independently predict early disease relapse.
Original languageEnglish
JournalBreast Cancer Research and Treatment
Issue number2
Publication statusPublished - Sep 1 2020

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