Baburin Aleksei, Aareleid Tiiu, Padrik Peeter, Valvere Vahur, Innos Kaire
Department of Epidemiology and Biostatistics, National Institute for Health Development , Tallinn , Estonia.
Acta Oncol. 2014 Feb;53(2):226-34. doi: 10.3109/0284186X.2013.806992. Epub 2013 Jun 14.
Survival from breast cancer (BC) in Estonia has been consistently among the lowest in Europe. The aim of this study was to examine most recent trends in BC survival in Estonia by age and stage. The trends in overall BC incidence and mortality are also shown in the paper.
Estonian Cancer Registry data on all cases of BC, diagnosed in women in Estonia during 1995-2007 (n = 7424) and followed up for vital status through 2009, were used to estimate relative survival ratios (RSR). Period hybrid approach was used to obtain the most recent estimates (2005-2009). Stage was classified as localized, local/regional spread or distant.
BC incidence continued to rise throughout the study period, but mortality has been in steady decline since 2000. The distribution of patients shifted towards older age and earlier stage at diagnosis. Overall age-standardized five-year RSR increased from 63% in 1995-1999 to 74% in 2005-2009. Younger age groups experienced a more rapid improvement compared to women over 60. Significant survival increase was observed for both localized and locally/regionally spread BC with five-year RSRs reaching 96% and 70% in 2005-2009, respectively; the latest five-year RSR for distant BC was 11%. Survival for T4 tumors was poor and large age difference was seen for locally/regionally spread BC.
Considerable improvement in BC survival was observed over the study period. Women under 60 benefited most from both earlier diagnosis and treatment advances of locally/regionally spread cancers. However, the survival gap with more developed countries persists. Further increase in survival, but also decline in BC mortality in Estonia could be achieved by facilitating early diagnosis in all age groups, but particularly among women over 60. Investigations should continue to clarify the underlying mechanisms of the stage-specific survival deficit in Estonia.
爱沙尼亚乳腺癌（BC）患者的生存率一直处于欧洲最低水平。本研究旨在按年龄和分期研究爱沙尼亚BC患者生存率的最新趋势。本文还展示了BC总体发病率和死亡率的趋势。
利用爱沙尼亚癌症登记处的数据，该数据涵盖了1995年至2007年期间爱沙尼亚女性中所有BC病例（n = 7424），并对其进行随访直至2009年以获取生命状态信息，用于估计相对生存率（RSR）。采用期间混合法来获得最新估计值（2005 - 2009年）。分期分为局限性、局部/区域扩散或远处转移。
在整个研究期间，BC发病率持续上升，但自2000年以来死亡率一直在稳步下降。患者分布在诊断时向年龄更大和分期更早转变。总体年龄标准化五年RSR从1995 - 1999年的63%增至2005 - 2009年的74%。与60岁以上女性相比，年轻年龄组的改善更为迅速。局限性和局部/区域扩散性BC的生存率均显著提高，2005 - 2009年五年RSR分别达到96%和70%；远处转移BC的最新五年RSR为11%。T4肿瘤的生存率较低，局部/区域扩散性BC存在较大年龄差异。
在研究期间观察到BC生存率有显著改善。60岁以下女性从局部/区域扩散性癌症的早期诊断和治疗进展中获益最大。然而，与更发达国家的生存差距依然存在。通过促进所有年龄组尤其是60岁以上女性的早期诊断，爱沙尼亚可能进一步提高生存率并降低BC死亡率。应继续开展研究以阐明爱沙尼亚特定分期生存不足的潜在机制。
