Geertje Miedema*, Mia Voordeckers, Christel Fontaine, Marian Vanhoeij, Guy Storme and Mark De Ridder
Purpose: This institutional-based study aims to reflect changes in diagnosis, surgery, radiotherapy, systemic therapy by retrospectively analysing treatment modalities and outcome during the past 30 years of breast cancer. We hypothesized these changes result in better outcome.
Material and methods: 2990 women are included, aged 18–95, no previous cancer, unilateral stage I-III primary breast tumors, breast-conserving surgery (BCS) or mastectomy (ME), postoperative radiotherapy (RT) and where indicated systemic treatment. Patients were divided in 3 cohorts stratified by year of diagnosis: 1984-1991, 1992- 1999 and 2000-2008. The interval of cohorts was based on institutional changes in systemic regimens.
Results: Over time, median age at diagnosis was similar, patients >70 year increased (19.5 to 25.7%). Over the 3 cohorts: stage migration is observed, determination of tumor grading became routine, proportions of known ER/PR status increased. Over time an obvious shift to less mutilating surgery is observed. Systemic treatment increased significantly during the observed period.
In stage I disease, overall (OS), local control (LC) and disease free survival (DFS) didn’t change. In stage II, a significant increase in 10 years OS and DFS (p= 0.02 and 0.001) is observed. In stage III we noticed a significant increase in 10 years DFS (p=0.04) and trend in increase of 10 years OS (p= 0.06). Local Recurrence free survival (RFS) didn’t change significantly for all stages.
Conclusion: This study demonstrated an improved outcome for stage II and III over time in our population with the same local control. This is multifactorial, reflecting changes in diagnostic imaging, surgery and increased use of systemic therapy.
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