VARIATION IN THE SURVIVAL OF WOMEN WITH BREAST-CANCER IN SCOTLAND

We have investigated factors influencing the survival of women with ea rly breast cancer in Scotland. In a retrospective study, clinical, tre atment and 'service' factors, e.g. surgical caseload, deprivation and geographical area (health board of first treatment) were recorded from hospital records. A total of 2148 women with invasive breast cancer d iagnosed in 1987 were identified from the Scottish Cancer Registry, of whom 1619 without metastases at diagnosis underwent surgery as part o f their primary treatment. In a multivariate analysis, clinical factor s (age, clinical stage, pathological tumour size, node status and oest rogen receptor status) all influenced survival, After allowing for the se clinical factors, surgical case toad and deprivation did not have s tatistically significant effects on survival. By contrast, health boar d did affect survival. This was explained in part by the selection of patients for surgery. There appeared, however, to be a residual effect that may be related to differences in the use of adjuvant systemic tr eatment among the different health boards. We conclude that, in Scotla nd, geographical Variation in both surgical and non-surgical treatment has a greater effect on variability in survival for women with breast cancer than surgical case load and deprivation.