Population-based study of breast cancer survival in Cote d'Or (France): prognostic factors and relative survival.

BACKGROUND: Few population-based studies have reported jointly analyses of relative survival according to the following prognostic factors: tumour-node-metastasis (TNM) stage, age, number of examined and positive nodes, hormonal status, histological Scarff, Bloom and Richardson (SBR) grade, tumour extension, hormone receptor status and tumour multifocal status. PATIENTS AND METHODS: Data on female invasive breast cancer were provided by the Cote d'Or breast cancer registry. The Kaplan-Meier method and log-rank test were used to estimate and compare the survival probability at 1, 5, 10 and 15 years. The effect of prognostic factors on survival was assessed with crude and relative multivariate survival analyses. RESULTS: Crude survival seemed to be worse in patients aged >60 years compared with those aged 45-60 (P > 0.0001), whereas relative survival did not differ. TNM stage, histological SBR grade, progesterone receptor status, tumour multifocal status, locoregional extension and the period of diagnosis were independent prognostic factors of crude and relative survival. CONCLUSION: Breast cancer is influenced by many factors. Despite the absence of any association between the number of examined nodes and overall survival in this study, the number of nodes removed, in conjunction with other prognostic factors, may be useful in selecting node-negative patients for systemic therapy.

Changing practice in systemic breast cancer adjuvant treatment in a well-defined French population.

Using the 2,208 non metastatic breast cancer diagnosed women who underwent breast surgery from the 2,432 first breast cancers recorded by the French département of Côte-d'Or cancer registry from 1982 to 1992, we described in this well-defined population, the trend in breast-cancer adjuvant treatment, and related practices with recommendations according to risk groups. Adjuvant treatment was received by 44.1% of the 2,208 women. Inflammatory tumors were systematically treated with chemotherapy. For the non-inflammatory M0 breast-cancer (2,167 women), the adjuvant treatment probability was mainly determined by the nodal involvement. After adjustment on the tumor- and host-characteristics, time period was associated with increased probability of adjuvant treatment in the whole group of patients and within each pN subgroup. In the group without nodal involvement, this increase was also associated with the SBR histologic grade. There was strong evidence of large changes in breast-cancer adjuvant treatment. Clinical practices in the Côte-d'Or region have paralleled the NIH recommendations. For node-negative breast cancers, these trends appeared despite persistent uncertainty in the definition of subgroups to treat. Over time, the SBR histologic grade became an apparent factor of treatment. This use as a treatment indicator was done without validation in any adjuvant treatment trial. The simultaneous recommendation to treat with the absence of guidelines could lead to the treating of an increasingly large group by extending the "high-risk" definition. This could be a non-optimal management of risk while putting strain on health care resources.

[Malpighian cancer of the anal canal in Côte-d'Or. Epidemiological and therapeutic aspects]. / Le cancer malpighien du canal anal en Côte-d'Or. Aspects épidémiologiques et thérapeutiques.

The registry of digestive tract tumours established for the department of Côte-d'Or was used to study the incidence and the treatment of squamous cell cancer of the anal canal. In the course of 7 years (1976-1982), 45 new cases of anal canal cancer were recorded. Age standardized rates using world standard population are 1.3/100,000 for females, 0.3/100,000 for males. As compared to other cancer registries, Côte-d'Or is in the high range for females, in the average range for males, the cases included 44% with T1-T2 tumours (less than 4 cm), 47% with T3-T4 tumours (more than 4 cm) and 9% unknown (Tx). Lymph node involvement was found in 1/3 of cases, metastatic disease in 11%. Six patients were treated by local excision, 13 by abdomino-perineal resection (combined with postoperative radiotherapy in 5 cases), 20 by radiotherapy (combined with a derivation in 2 cases) and 6 by symptomatic treatment. For T1-T2 normal anal function was preserved in 79% of cases. The 5 year local recurrence rate for curative treatment was 44%. The 5 year observed survival rate was 42.6%; the 5 year relative survival rate was 53.3%. The survival was related to the age, to the sex, to the size of the tumour, and to the nodal status.

[Absences from school in Basle primary pupils]. / Schulabsenzen bei Basler Primarschülern.

In the lower income group children of full-time working mothers have the lowest average of school absences, whereas in the higher income group they have the highest average. School absences of children in the lower income group increase markedly with increasing learning problems which might point out class differences of our schools.