Montagna Giacomo, Schaffar Robin, Bordoni Andrea, Spitale Alessandra, Terribile Daniela A, Rossi Lorenzo, Bergeron Yvan, van der Linden Bernadette W A, Konzelmann Isabelle, Rohrmann Sabine, Staehelin Katharina, Maspoli-Conconi Manuela, Bulliard Jean-Luc, Meani Francesco, Pagani Olivia, Rapiti Elisabetta
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10001, USA.
Geneva Cancer Registry, University of Geneva, 1205 Geneva, Switzerland.
Cancers (Basel). 2022 Mar 4;14(5):1328. doi: 10.3390/cancers14051328.
Background: An increase in breast cancer (BC) incidence in young women (YW) as well as disparities in BC outcomes have been reported in Switzerland. We sought to evaluate treatment and outcome differences among YW with BC (YWBC). Methods: YW diagnosed with stage I-III BC between 2000−2014 were identified through nine cancer registries. Concordance with international guidelines was assessed for 12 items covering clinical/surgical management, combined in a quality-of-care score. We compared score and survival outcome between the two linguistic-geographic regions of Switzerland (Swiss-Latin and Swiss-German) and evaluated the impact of quality-of-care on survival. Results: A total of 2477 women were included. The median age was 37.3 years (IQR 34.0−39.4 years), with 50.3% having stage II BC and 70.3% having estrogen receptor positive tumors. The mean quality-of-care score was higher in the Latin region compared to the German region (86.0% vs. 83.2%, p < 0.0005). Similarly, 5- and 10-year overall survival rates were higher in the Latin compared to the German region (92.3% vs. 90.2%, p = 0.0593, and 84.3% vs. 81.5%, p = 0.0025, respectively). There was no difference in survival according to the score. In the univariate analysis, women in the Latin region had a 28% lower mortality risk compared to women in the German region (hazard ratio 0.72; 95% CI 0.59−0.89). In the multivariable analysis, only stage, differentiation, tumor subtype and treatment period remained independently associated with survival. Conclusions: We identified geographic disparities in the treatment and outcome of YWBC in Switzerland. National guidelines for YWBC should be implemented to standardize treatment. Awareness should be raised among YW and clinicians that BC does not discriminate by age.
瑞士报告称年轻女性乳腺癌（BC）发病率上升，且乳腺癌治疗结果存在差异。我们试图评估年轻女性乳腺癌（YWBC）患者的治疗及预后差异。方法：通过九个癌症登记处识别出2000年至2014年间诊断为I - III期乳腺癌的年轻女性。对涵盖临床/手术管理的12项内容与国际指南的一致性进行评估，并合并为护理质量评分。我们比较了瑞士两个语言地理区域（瑞士拉丁区和瑞士德语区）的评分及生存结果，并评估了护理质量对生存的影响。结果：共纳入2477名女性。中位年龄为37.3岁（四分位间距34.0 - 39.4岁），50.3%为II期乳腺癌，70.3%为雌激素受体阳性肿瘤。拉丁区的平均护理质量评分高于德语区（86.0%对83.2%，p < 0.0005）。同样，拉丁区的5年和10年总生存率高于德语区（分别为92.3%对90.2%，p = 0.0593；84.3%对81.5%，p = 0.0025）。根据评分，生存率无差异。单因素分析中，拉丁区女性的死亡风险比德语区女性低了28%（风险比0.72；95%置信区间0.59 - 0.89）。多因素分析中，只有分期、分化程度、肿瘤亚型和治疗时期与生存独立相关。结论：我们发现瑞士年轻女性乳腺癌患者的治疗和预后存在地理差异。应实施针对年轻女性乳腺癌的国家指南以规范治疗。应提高年轻女性和临床医生对乳腺癌不因年龄而有差异的认识。
