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Trends in the usage of adjuvant systemic therapy for breast cancer in the Netherlands and its effect on mortality

Authors
Journal
British Journal of Cancer
0007-0920
Publisher
Nature Publishing Group
Publication Date
Identifiers
DOI: 10.1038/sj.bjc.6601969
Keywords
  • Clinical
Disciplines
  • Biology
  • Medicine

Abstract

Trends in the usage of adjuvant systemic therapy for breast cancer in the Netherlands and its effect on mortality MM Vervoort1,2, G Draisma1, J Fracheboud1, LV van de Poll-Franse3 and HJ de Koning*,1 1Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands; 2Netherlands Institute for Health Sciences, PO Box 1738, 3000 DR Rotterdam, The Netherlands; 3Comprehensive Cancer Centre South (IKZ), PO Box 231, 5600 AE Eindhoven, The Netherlands Adjuvant systemic therapy was introduced in the Netherlands as a breast cancer treatment in the early 1980s. In this paper, we describe the trends in the usage of adjuvant systemic treatment in the period 1975–1997 in the Netherlands. The main aim of our study was to assess the effects of adjuvant tamoxifen and polychemotherapy on breast cancer mortality, compared to the effects of the mammography screening programme. The computer simulation model MIcrosimulation SCreening ANalysis, which simulates demography, natural history of breast cancer and screening effects, was used to estimate the effects. Use of adjuvant therapy increased over time, but since 1990 it remained rather stable. Nowadays, adjuvant therapy is given to 88% of node-positive patients aged 50–69 years, while less than 10% of node-negative patients receive any kind of adjuvant treatment. Adjuvant treatment is given independent of the mode of detection (adjusted by nodal status and size). We predict that the reduction in breast cancer mortality due to adjuvant therapy is 7% in women aged 55–74 years, while the reduction due to screening, which was first implemented in women aged 50–69 years in 1990–97, will be 28–30% in 2007. In conclusion, although adjuvant systemic therapy can reduce breast cancer mortality rates, it is anticipated to be less than the mortality reduction caused by mammography screening. British Journal of Cancer (2004) 91, 242–247. doi:10.1038/sj.bjc.6601969 www.bjcancer.com Published online 22 June 2004

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