Wide variations in treatment for breast cancer in Europe, USA and
15 April 2010
A global study of nearly 10,000 women with early breast cancer
has found wide variations in how they were treated, despite
international consensus on best practice, according to the May issue of
the British Journal of Surgery.
Researchers from Europe, Japan and America compared 9,779 women
with an average age of 64 from 566 study sites in Belgium, France,
Germany, Greece, Japan, the Netherlands, the UK, Ireland and the
“The primary aim of our five-year research study was to carry out
an international randomised trial to evaluate the efficacy and
safety of the breast cancer drug xemestane, alone or following
tamoxifen” explains co-author Professor C J H van de Velde from
Leiden University Medical Center in The Netherlands.
“However, because we had recruited a large number of patients, we
decided that this also provided us with an invaluable opportunity to
examine how different countries treat postmenopausal women with
early breast cancer.
“The results of our study show wide international variations in
the percentages of women who receive breast conserving surgery (BCS)
rather than breast removal (mastectomy) and radiotherapy after
KKey findings of the study included:
- 58% per cent of the women had T1 tumours (less than 2cm),
37% had T2 tumours (2-5cm) and 5% had larger/more advanced
- 47% of the women had axillary node-positive disease, where
the cancer affects the lymph nodes.
- The highest percentage of node-negative disease was observed
in the countries with the highest percentage of T1 tumours — the
USA, France and Germany.
- In general, women with T1 tumours were more likely to
receive BCS. However, despite the fact that T1 tumour rates were
similar in the USA and France (74% and 76% respectively), 89% of
T1 tumours were treated with BCS in France compared with only
55% in the USA.
- Women with T2 tumours were more likely to receive a
mastectomy than BCS, but this varied widely between countries,
from 42% in France to 69% in the USA.
- The overall mastectomy rate for all tumours was 44%, with
the lowest rate in France (19%) and the highest rate in Greece
- BCS was highest in women aged between 50 and 70 and
mastectomy rates were highest in women under 50.
- Despite international guidelines that radiotherapy should be
part of breast-conserving therapy, France and Belgium were the
only countries to report 100% treatment rates. The highest
non-treatment rates were in Japan (where 14% of patients did not
receive radiotherapy), the UK and Ireland (13%) and the USA
- 39% of women received radiotherapy after a mastectomy and
93% of women received radiotherapy after BCS treatment.
- Some 82% of patients underwent Axillary Lymph Node
Dissection, ranging from 75% in the USA to 99% in the UK and
“Our study showed that despite international consensus
guidelines, there are wide global variations in the way
postmenopausal women are treated for early breast cancer” concludes
Professor van de Velde.
“We believe that there should be further efforts to ensure that
women can all benefit from the most effective breast cancer
treatment available, regardless of which country they live in.” /p>
TThe TEAM (Tamoxifen and Exemestane Adjuvant Multinational) trial
covered nine countries: Belgium (414 women), France (1,230), Germany
(1,471), Greece (207), Japan (184), The Netherlands (2,753), UK and
Ireland (1,275) and USA (2,232).
A 20-minute podcast, produced to coincide with publication of the
paper, can be accessed at:
1. van Nes et al. Variations in locoregional therapy in
postmenopausal patients with early breast cancer treated in
different countries. British Journal of Surgery.
97(5), pp 671-679. (May 2010). DOI: 10.1002/bjs.6962
The paper is free online at: