Projects 

Impact of socioeconomic status on breast cancer quality care and prognosis

Socioeconomic status (SES) disparities on breast cancer prognosis have been described but the reasons behind their impact on mortality remain to be established. With this population-based study, we aim to evaluate if SES differences in breast cancer characteristics and quality of care can explain SES inequalities in breast cancer mortality. We include a total of 1068 invasive breast cancer patients recorded in GCR between 2003 and 2005. SES was based on woman’s last occupation, and when absent that of the spouse. We compared patient, tumour and treatment characteristics, as well as quality of care indicators established by the European Society of breast Cancer Specialists between high and low SES by logistic regression. We applied Cox regression analyses to identify reasons for the SES inequalities in breast cancer specific survival.

Breast cancer quality of care and outcome according to surgeon’s caseload

The surgeons experience in breast cancer surgery appears to be a predictor of patient’s survival. However, due to quality disparities in the existing studies, there is still ambiguity surrounding both the relation and reasons why surgeon skill could influence breast cancer mortality. This population-based study aims to evaluate the effect of surgeon volume on both breast cancer quality of care and specific mortality, taking into account patient selection bias. The study included 1489 women, who operated in Geneva in the private sector for invasive breast cancer between 2000- 2009, recorded in the GCR and followed until 31 December 2014.

Impact of neoadjuvant treatment in breast cancer patients

There is still little information about the impact of neoadjuvant chemotherapy after breast cancer diagnosis in terms of recurrences, which limits the optimisation of the sentinel lymph node biopsy procedure, and the use of adjuvant radiotherapy. Among all women diagnosed in Geneva from 2000 to 2013 (n=4240), we collected the information about loco-regional recurrences among all women who received neoadjuvant chemotherapy (n = 354). We also collected data on tumour characteristics pre- and post-chemotherapy, pathological complete remission, and also breast cancer specific and overall survival up to December 2014. The aim of the study was to evaluate the pattern, predictors and impact of loco-regional recurrences among women treated with preoperative neoadjuvant chemotherapy.

Temporal evolution of survival of breast cancer women whose cancer has not been detected through screening mammography

Breast cancer mortality has been declining in many western countries, includ- ing Switzerland, starting from the late 80s. Mammography screening and improvements in treatments have been credited with different degree for this reduction. Mortality trends are also decreasing among unscreened women, however, most of breast cancer deaths still occur among unscreened women. The objective of this study was to analyse trends of factors affecting survival of women within the unscreened female population in Geneva, start- ing from 1990 through to 2007. An organised screening program launched in Geneva in 2001, whilst opportunistic screening has been in existence since the beginning of the 90s.