Variation in "Standard care" for breast cancer across Europe: a EUROCARE-3 high resolution study

Abstract On a population-based sample of 13,500 European breast cancer patients mostly diagnosed in 1996–1998 and archived by 26 cancer registries, we used logistic regression to estimate odds of conservative surgery plus radiotherapy (BCS + RT) versus other surgery, in T1N0M0 cases by country, adjusted for age and tumour size. We also examined: BCS + RT in relation to total national expenditure on health (TNEH); chemotherapy use in N + patients; tamoxifen use in oestrogen-positive patients; and whether ⩾10 nodes were examined in lymphadenectomies. Stage, diagnostic examinations and treatments were obtained from clinical records. T1N0M0 cases were 33.0% of the total. 55.0% of T1N0M0 received BCS + RT, range 9.0% (Estonia) to 78.0% (France). Compared to France, odds of BCS + RT were lower in all other countries, even after adjusting for covariates. Women of 70–99 years had 67% lower odds of BCS + RT than women of 15–39 years. BCS + RT was 20% in low TNEH, 58% in medium TNEH, and 64% in high TNEH countries. Chemotherapy was given to 63.0% of N + and 90.7% of premenopausal N + (15–49 years), with marked variation by country, mainly in post-menopause (50–99 years). Hormonal therapy was given to 55.5% of oestrogen-positive cases, 44.6% at 15–49 years and 58.8% at 50–99 years; with marked variation across countries especially in premenopause. The variation in breast cancer care across Europe prior to the development of European guidelines was striking; older women received BCS + RT much less than younger women; and adherence to ‘standard care’ varied even among countries with medium/high TNEH, suggesting sub-optimal resource allocation.