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Br J Cancer. 2016 Nov 22;115(11):1408-1415. doi: 10.1038/bjc.2016.335. Epub 2016 Oct 25.

Short-term breast cancer survival in relation to ethnicity, stage, grade and receptor status: national cohort study in England.

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Cancer Epidemiology, Population and Global Health, King's College London, Bermondsey Wing, 3rd Floor, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
National Cancer Registration and Analysis Service, Public Health England, Skipton House, 80 London Road, London SE1 6LH, UK.
Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health, Aarhus University, Nordre Ringgade 1, Aarhus C 8000, Denmark.
School of Medicine, University of Leeds, Leeds, West Yorkshire, LS9 7TF, UK.
Department of Breast Surgery, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.
Departments of Medical Statistics and Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.



In the re-organisation of cancer registration in England in 2012, a high priority was given to the recording of cancer stage and other prognostic clinical data items.


We extracted 86 852 breast cancer records for women resident in England and diagnosed during 2012-2013. Information on age, ethnicity, socio-economic status, comorbidity, tumour stage, grade, morphology and oestrogen, progesterone and HER2 receptor status was included. The two-year cumulative risk of death from any cause was estimated with the Kaplan-Meier method, and univariate and multivariate Cox proportional hazards regressions were used to estimate hazard ratios (HR) and their 95% confidence intervals (95% CI). The follow-up ended on 31 December 2014.


The completeness of registration for prognostic variables was generally high (around 80% or higher), but it was low for progesterone receptor status (41%). Women with negative receptor status for each of the oestrogen, progesterone and HER2 receptors (triple-negative cancers) had an adjusted HR for death of 2.00 (95%CI 1.84-2.17). Black women had an age-adjusted HR of 1.77 (1.48-2.13) compared with White women.


The excess mortality of Black women with breast cancer has contributions from socio-economic factors, stage distribution and tumour biology. The study illustrates the richness of detail in the national cancer registration data. This allows for analysis of cancer outcomes at a high level of resolution, and may form the basis for risk stratification.

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Conflict of interest statement

Katherine Henson has in the past been an employee of BUPA. Ruth Jack and Elizabeth Davies have received research funding for an unrelated project from Hospital Corporation of America International. All other authors declare no conflict of interest. The views expressed are those of the authors and not necessarily those of CRUK, the NHS, the NIHR or the Department of Health. The researchers were independent of the funders, and the researchers alone interpreted the data and decided to publish.

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