Changing patterns of breast cancer stage at diagnosis in Southern Italy: Hospital data as indicators of progressive changes

Background. In southern Italy diagnostic delay in breast cancer patients ha s been demonstrated to be related to the level of education and residency i n rural areas. In order to verify whether late breast cancer diagnosis was actually in decline as a result of improving socioeconomic conditions and o ngoing prevention programs, we evaluated clinical data from the tumor regis try of the National Cancer Institute, Naples. Methods. Four thousand two hundred forty consecutive breast cancer patients admitted to our institution from 1986 to 1997 were grouped into four 3-yea r periods according to their admission date. Using multiple logistic regres sion, chi(2) for trend and beta-coefficient were calculated in each pT and pN categories in order to discover the trend for the 1986-1997 period. Results. A progressive, statistically significant decrease in the number of patients with advanced cancer at the time of diagnosis was observed over t he study period. In particular, chi(2) values for trend for each pT categor y, over the study period, were pT1 119.4 (P < 0.001) with positive beta-coe fficient, pT2 13.4 (P = 0.003) with negative beta, and pT3-pT4 152.2 (P < 0 .001) with the strongest negative beta. Conclusions. Changing patterns of breast cancer stage at diagnosis have bee n demonstrated in women living in Southern Italy. They are consistent with an increasing orientation toward prevention. Data from hospital tumor regis tries are a useful source of information on diagnostic delay. (C) 2000 Amer ican Health Foundation and Academic Press.