Improving survival for patients with breast cancer compared with intramural and extramural benchmarks

Advances in the early detection and treatment of breast cancer during the past 20 years should have been associated with increased survival.

We examined outcomes for patients with invasive breast cancer diagnosed before and after opening a hospital-affiliated comprehensive community cancer center and compared rates of improvement in survival with national benchmarks. Survival data for patients with invasive cancer were obtained from the Hoag Hospital tumor registry. National Surveillance Epidemiology and End Results (SEER) survival data for all eras reported for 1981-2001 were used for extramural comparisons.

Observed 5-year survival improved from 79% to 84% (P=0.003) for patients diagnosed with invasive breast cancer during 1986-1991 compared with 1992-1999, the eras immediately before and after opening Hoag Cancer Center. During 1981-1993, relative 5-year survival rates increased slowly, nationally and locally, with both at 86% for 1986-1993. Since then, Hoag relative 5-year survival rates have steadily increased to 97% compared with 88% for SEER during 1995-2001. Improved survival for Hoag patients was observed for all general stages of disease and associated with increased use of systemic treatment and radiation therapy in addition to surgery.

The existence of Hoag Cancer Center has been associated with improved survival for patients with invasive breast cancer and for all stages of disease. The rate of improvement has been more rapid than observed nationally. Systematic dissemination of new information might have resulted in earlier adoption of improved screening and diagnostic and multidisciplinary treatment approaches that led to higher survival rates.