Primary local treatment of breast cancer patients – a high resolution study from the population based Saarland Cancer Registry

Background: So far, only few studies have addressed patterns and underlying factors of provision of breast cancer (BRC) treatment on a population level in Germany. Material and Methods: Routine data from the population based Saarland Cancer Registry was extended with detailed clinical information by review of individual medical records of 2300 out of 2479 patients (93%) with primary invasive BRC diagnosed in 2000–2002. Provision of surgery and radiotherapy according to available consensus recommendations on treatment of primary BRC without distant metastasis were examined by age and tumour stage. Multiple logistic regression analysis was used to investigate further determinants like tumour characteristics, residence and type of hospital. Results: Overall, 91% of the patients received recommended local treatment consisting of either breast conserving surgery (BCS) and adjuvant radiotherapy or mastectomy. The proportion of patients with local surgery was 96% (BCS: 66%, mastectomy: 37%). 92% of patients with surgery were axillary staged. The provision of mastectomy as first surgery varied significantly by age, tumor stage, area of residence and care level of hospital. Radiotherapy was given to 68% of the patients (BCS patients: 86%, patients with mastectomy: 50%). Overall, patients aged 70 years or older received BCS, axillary staging and adjuvant radiotherapy less often compared to younger patients (differences of 26, 18 and 34 percentage points respectively). Discussion/Conclusions: Data from population based cancer registries may provide a valuable tool for measuring access and provision of cancer care on a population level, if detailed clinical information on cancer treatment is available. This study showed overall good adherence to consensus recommendations with respect to local treatment. However, substantial variation of treatment by age was observed. The study further indicated major variation in health care provision between different counties and hospitals.