Improvements in Outcomes for Patients with Early Breast Cancer Over the Past 20 Years

Presenter Carolyn Taylor and team present data on improvements in outcomes for women with early breast cancer from 1993 to 2015 in England. The study highlights patient and tumor factors, breast cancer mortality rates, long-term follow-up data, and the need for big data analysis. The research focuses on trends in breast cancer mortality, age-specific mortality rates, ER status impact, and adjusted annual mortality rates, considering various factors such as time since diagnosis, age, and screening. The study reflects progress in understanding and managing early invasive breast cancer, showing a decrease in breast cancer deaths by the end of the follow-up period, with a call for continued data analysis and research to enhance patient outcomes.

• Breast Cancer
• Patient Outcomes
• Early Detection
• Mortality Rates
• Research Data

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1. Improvements in outcomes for patients with early breast cancer during the past 20 years Presenter: Carolyn Taylor Paul McGale, Jake Probert, John Broggio, Jackie Charman, Sarah Darby, Amanda Kerr, Tim Whelan, David Cutter, Gurdeep Mannu, David Dodwell 1

2. Women with early breast cancer Patient factors Tumour factors Breast cancer mortality Long-term follow-up Big data needed 2

3. Public Health England data Women with breast cancer in England. Diagnosed 1993 to 2015 N=783,980 Exclusions Other histology/non-invasive Age <18 or 90+ years Lost to follow-up, died or second cancer within 3 months Probable metastatic disease No surgery Neoadjuvant chemotherapy N=271,533 Women received surgery as first treatment for early breast cancer N=512,447 3

4. Women with Early Invasive Breast Cancer 1993-2015 Follow-up No. women starting follow-up period % Followed for at least 5 years 300,501 253,661 130,621 50,570 57 49 25 10 10 years 15 years 20 years By end of follow-up (31 Dec 2020) 77,975 Breast cancer deaths 4

5. Breast cancer mortality: Calendar year of diagnosis N=512,447 Annual Cumulative 14% 5% 5

6. Breast cancer mortality: Calendar year of diagnosis Age 50-64 years by screen-detection Non-screen-detected cancers N=114,936 Screen-detected cancers N=99,105 6

7. Breast cancer mortality: ER status N=512,447 Annual mortality Cumulative mortality 7

8. Adjusted for: - Time since diagnosis - Calendar year of diagnosis - Age at diagnosis - Screen detection - Laterality - Index of multiple deprivation - Region Breast cancer mortality Adjusted annual rates Adjusted annual mortality rate % Low Medium High 1-20 21-50 >50 0 1 to 3 4 to 9 10 or more

9. Adjusted for: - Time since diagnosis - Tumour size - Number of positive nodes - Tumour grade - Laterality - Index of multiple deprivation - Region Breast cancer mortality Adjusted annual rates Adjusted annual mortality rate % 1993- 2000- 2005- 2010- 1999 2004 2009 2015 Yes No Ineligible 18-39 40-49 50-64 65-70 71-79 80-89

10. Breast cancer mortality Adjusted annual rates Calendar year of diagnosis Adjusted for: - Time since diagnosis - Screen detection - Tumour size - Number of positive nodes - Tumour grade - Laterality - Index of multiple deprivation - Region Adjusted annual mortality rate % 1993- 2000- 2005- 2010- 1999 2004 2009 2015 1993- 2000- 2005- 2010- 1999 2004 2009 2015 1993- 2000- 2005- 2010- 1999 2004 2009 2015 1993- 2000- 2005- 2010- 1999 2004 2009 2015 1993- 2000- 2005- 2010- 1999 2004 2009 2015 1993- 2000- 2005- 2010- 1999 2004 2009 2015

11. Adjusted for: - Time since diagnosis - Age - Tumour size - Number of positive nodes - Tumour grade - Laterality - Index of multiple deprivation - Region Breast cancer mortality Adjusted annual rates Calendar year of diagnosis 1993- 2000- 2005- 2010- 1999 2004 2009 2015 1993- 2000- 2005- 2010- 1999 2004 2009 2015 1993- 2000- 2005- 2010- 1999 2004 2009 2015

12. Adjusted for: - Time since diagnosis - Age - Screen detection - Tumour size - Number of positive nodes - Tumour grade - Laterality - Index of multiple deprivation Breast cancer mortality Adjusted annual rates Calendar year of diagnosis

13. Breast cancer mortality: Calendar year of diagnosis N=512,447 Annual Cumulative 13

14. Cumulative 5-year breast cancer risks Women diagnosed 2010-2015 N=28,892 Cumulative 5-year breast cancer mortality risk (%) 14

15. Conclusions Data on 500,000 women in England, followed for up to 20 years Average 5-year risk of dying from breast cancer has fallen from 14% to 5% since the 1990s For 63% of women diagnosed 2010-2015 risk was <3% For 5% of women diagnosed 2010-2015 risk was >20% Most women diagnosed with early invasive breast cancer today can expect to become long-term cancer survivors 15

16. Thanks to Half a million women in the study Two patient advocates who informed it Many researchers in Public Health England and in Oxford Population Health 16

17. Cancer patients can make a difference 17

18. Questions 18