A POPULATION-BASED SURVIVAL STUDY ON FEMALE BREAST-CANCER IN MADRAS, INDIA

Breast cancer is the second most common cancer among women in Madras a nd 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 i n MMTR during 1982-89. Of these, 98 (4.7%) cases were registered on th e basis of death certificate information only (DCO), and there was no follow-up information for 235 (11.3%). These were excluded, leaving 17 47 (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 rela tive survival were 81%, 61% and 51%. A multifactorial analysis of prog nostic factors using a proportional hazards model showed statistically significant differences in survival for subjects in different categor ies of age at diagnosis, marital status, educational level and clinica l extent of disease. Increasing age at diagnosis was associated with d ecreased survival. Single women displayed poorer survival (37.4%) at 5 years than those married and living with spouses (50.0%). The surviva l 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 re lationship was seen between survival rates and clinical extent of dise ase. The need for research to determine feasible public health approac hes, allied to coordinated treatment facilities to control breast canc er in India, is emphasized.