With better adjuvant therapy, does breast cancer stage still matter?

Breast cancer mortality is declining throughout the Western world.1 2 3 If, as J F Kennedy said, “victory has a thousand fathers,” then progress in breast cancer surely has a lot of parents. In the late 1970s, guidelines recommended screening mammography for women over the age of 40, resulting in implementation of national and regional screening programmes in most developed countries. Soon after, adjuvant endocrine therapy and chemotherapy were found to reduce the risk of breast cancer recurrence and death.4 5 Meanwhile, the combination of early detection and effective radiation therapy enabled breast conserving surgery as an option for most women.6 The implementation of these truly multidisciplinary treatment programmes, combining local and systemic treatments with public health screening initiatives and health awareness campaigns, revolutionised and improved breast cancer care.

The linked paper by Saadatmand and colleagues brings that progress forward into the 21st century.1 Using a population based cohort of 173 797 patients and comparing patterns of care and outcomes in two time periods (1999-2005 v 2006-12), they document steadily improving survival for women with breast cancer in the Netherlands. Dutch …