5. QUALITY OF CARE • CANCER CARE 5.9. Screening, survival and mortality for breast cancer Breast cancer is the most prevalent form of cancer in Coleman et al., 2008, 2011). The relative five-year breast women, accounting for almost 460 000 deaths worldwide cancer survival rates have improved in all countries in 2008 (WHO, 2011d). One in nine women will acquire between 1997-2002 and 2004-09 (Figure 5.9.2). Most OECD breast cancer at some point in her life and one in thirty will countries have survival rates of over 80%, with notable die from the disease. There are a number of risk factors increases in Ireland, the Czech Republic and Slovenia. that increase a person’s chance of getting this disease such Recent studies suggest that some of the differences in as age, family history of breast cancer, estrogen replace- survival rates could be due to variations in the implemen- ment therapy, alcohol use and others. Overall spending for tation of screening programmes and different improve- breast cancer care typically amounts to about 0.5-0.6% of ment rates between middle aged and elderly patients total health expenditure (OECD, 2003a). Variation in breast (Rosso et al., 2010). cancer care across OECD countries is indicated by mam- Mortality rates reflect the effect of improvements in early mography screening rates in women aged 50-69 years, detection and treatment of breast cancer. Overall, the relative survival rates, and mortality rates. breast cancer mortality rates have declined in most OECD The promotion of screening mammography (European countries over the past decade (Figure 5.9.3). Improvements Union, 2003) and self-examination have led to the detection were substantial in Estonia, the Czech Republic, the of the disease at earlier stages. Most OECD countries have Netherlands, the United Kingdom, Luxembourg and adopted breast cancer screening programmes as the most Norway. The exceptions are Korea, Japan, Iceland and effective way for detecting the disease. The periodicity and Mexico, but the increases in these countries were modest population target groups vary across member states and and the mortality rates continue to be among the lowest in are still the subjects of debate. EU guidelines (European OECD countries. Commission, 2006) promote a desirable target screening rate of at least 75% of eligible women in European countries. Screening rates continue to vary widely across OECD coun- tries in 2009, ranging from 12% in Turkey and 16-17% in the Slovak Republic and Mexico, up to over 80% in Finland, the Definition and comparability Netherlands and the United States (Figure 5.9.1). Some Mammography screening rates reflect the proportion countries that already had high screening rates in 2000 of eligible women patients who are actually screened. experienced a reduction over the past decade, including As policies regarding target age groups and screening Finland, the United States, Norway and the United Kingdom. periodicity differ across countries, the rates are based By contrast, the rates have increased a lot in Hungary and on each country’s specific policy. Some countries the Slovak Republic, although they remain well below the ascertain screening based on surveys and others OECD average. based on encounter data, and this may influence Breast cancer survival rates reflect advances in public results. Survey-based results may be affected by recall health interventions, such as greater awareness of the bias. If a country has an organised screening disease, screening programmes, and improved treatment. programme, but women receive care outside of the In particular, the introduction of combined breast conser- programme, rates may be underreported. ving surgery with local radiation and neoadjuvant therapy Survival rates and mortality rates are defined in have increased survival as well as the quality of life of Indicator 5.8 “Screening, survival and mortality for survivors (Mauri et al., 2008). Resources and patterns for cervical cancer”. breast cancer treatment vary substantially across OECD countries, leading to an interest in comparing survival Information on data for Israel: http://dx.doi.org/10.1787/ rates under the EUROCARE, CONCORD and International 888932315602. Cancer Benchmarking Partnership studies (Sant et al., 2009; 120 HEALTH AT A GLANCE 2011: OECD INDICATORS © OECD 2011 5. QUALITY OF CARE • CANCER CARE 5.9. Screening, survival and mortality for breast cancer 5.9.1 Mammography screening, percentage of women 5.9.2 Breast cancer five-year relative survival rate, aged 50-69 screened, 2000 to 2009 (or nearest year) 1997-2002 and 2004-09 (or nearest period) 2009 2000 2004-09 1997-2002 Finland1 84.4 89.3 87.4 United States 88.6 Netherlands1 82.1 80.5 87.3 2 81.1 Japan 86.1 United States 86.9 France2 76.7 86.6 Canada 85.6 1 74.1 Norway 79.2 86.5 1 74.0 Norway 82.4 United Kingdom 75.3 1 73.7 86.3 Denmark Finland 84.2 1 73.1 Ireland 76.3 Iceland 86.3 Canada2 72.5 72.7 86.2 Spain2 71.8 Belgium 69.5 Israel1 Sweden 86.0 1 66.9 83.1 New Zealand 63.0 84.5 62.2 New Zealand 77.0 OECD15 59.9 Luxembourg1 61.0 84.4 53.8 Netherlands 79.5 Iceland1 61.0 61.0 OECD16 83.5 Italy1 60.0 78.7 1 59.0 Germany 83.3 Belgium 50.0 74.5 1 54.9 Australia 55.9 France Greece2 53.8 82.8 53.6 82.2 Germany2 Korea 76.7 52.0 Estonia1 Portugal 82.0 1 51.4 Korea 82.0 1 49.1 Denmark 76.2 Hungary 26.7 Czech Republic1 48.5 81.3 United Kingdom 75.0 Slovenia2 47.2 Austria 81.2 Chile1 31.8 79.3 2 23.8 Ireland 80.3 Japan 22.5 72.3 1 16.6 Mexico Czech Republic 78.6 1 16.0 70.8 Slovak Republic 6.9 12.4 76.9 Turkey1 Slovenia 67.9 0255075100 0420 06080 100 % of women screened Age-standardised rates (%) 1. Programme. 2. Survey. Note: 95% confidence intervals are represented by H. Source: OECD Health Data 2011. Source: OECD Health Data 2011. 1 2 http://dx.doi.org/10.1787/888932525419 1 2 http://dx.doi.org/10.1787/888932525438 5.9.3 Breast cancer mortality, females, 2000 to 2009 (or nearest year) 2000 2009 Age-standardised rates per 100 000 females 35 31.5 30.6 30.5 33.4 29.4 28.8 30 28.6 27.2 27.0 27.0 26.1 25.8 25.6 25.6 25.4 25.0 24.7 24.6 24.5 24.3 24.1 23.9 23.6 25 23.6 23.2 23.1 22.9 22.5 22.3 22.1 21.6 21.4 21.2 21.1 21.0 20.8 20.3 20.0 19.9 19.8 19.8 19.8 19.7 19.7 19.4 19.3 19.1 19.1 18.9 18.6 18.6 20 18.5 18.1 17.7 17.4 16.4 15.7 15 13.4 11.4 10.8 10.8 10 9.7 6.1 5 4.9 0 Italy Korea Japan Chile Spain OECD Israel Mexico NorwayFinland Poland GreeceIceland Estonia Austria France Ireland PortugalAustralia Sweden Germany Slovenia Hungary Denmark Switzerland Netherlands United States Luxembourg New Zealand Czech Republic Slovak Republic United Kingdom Source: OECD Health Data 2011. 1 2 http://dx.doi.org/10.1787/888932525457 HEALTH AT A GLANCE 2011: OECD INDICATORS © OECD 2011 121 From: Health at a Glance 2011 OECD Indicators Access the complete publication at: https://doi.org/10.1787/health_glance-2011-en Please cite this chapter as: OECD (2011), “Screening, survival and mortality for breast cancer”, in Health at a Glance 2011: OECD Indicators, OECD Publishing, Paris. 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