A population-based survival study on female breast cancer in Madras, India

Breast cancer is the second most common cancer among women in Madras and southern India after cervix cancer. The Madras Metropolitan Tumour Registry (MMTR), a population-based cancer registry, collects data on the outcome of cancer diagnosis by both active and passive methods. A total of 2080 cases of invasive female breast cancer were registered in MMTR during 1982-89. Of these, 98 (4.7%) cases were registered on the basis of death certificate information only (DCO), and there was no follow-up information for 235 (11.3%). These were excluded, leaving 1747 (84%) for survival analysis. The mean follow-up time was 43 months. The overall Kaplan-Meier observed survival rates at 1, 3 and 5 years were 80%, 58% and 48% respectively; the corresponding figures for relative survival were 81%, 61% and 51%. A multifactorial analysis of prognostic factors using a proportional hazards model showed statistically significant differences in survival for subjects in different categories of age at diagnosis, marital status, educational level and clinical extent of disease. Increasing age at diagnosis was associated with decreased survival. Single women displayed poorer survival (37.4%) at 5 years than those married and living with spouses (50.0%). The survival rate among those who had more than 12 years of education was higher (70%) at 5 years than that of illiterate subjects (47%). An inverse relationship was seen between survival rates and clinical extent of disease. The need for research to determine feasible public health approaches, allied to coordinated treatment facilities to control breast cancer in India, is emphasized.