M. Crommelin - Academia.edu (original) (raw)
Papers by M. Crommelin
JNCI Journal of the National Cancer Institute, 2003
Background: Female survivors of Hodgkin's disease (HD) have a strongly elevated risk of breast ca... more Background: Female survivors of Hodgkin's disease (HD) have a strongly elevated risk of breast cancer, but factors responsible for the increased risk are not well known. Methods: We investigated the effects of radiation dose, chemotherapy (CT), and reproductive factors on breast cancer risk in a nested case-control study in The Netherlands in a cohort of 770 female patients who had been diagnosed with HD before age 41. Detailed treatment information and data on reproductive factors were collected for 48 case patients who developed breast cancer 5 or more years after diagnosis of HD and 175 matched control subjects. The radiation dose was estimated to the area of the breast where the case patient's tumor had developed and to a comparable location in matched control subjects. Relative risks (RRs) of breast cancer were calculated by conditional logistic regression. Statistical tests were two-sided. Results: The risk of breast cancer increased statistically significantly with radiation dose (P trend = .01); patients who received 38.5 Gy or more had an RR of 4.5 (95% confidence interval [CI] = 1.3 to 16) times that of patients who received less than 4 Gy. Patients who received both CT and radiotherapy (RT) had a statistically significantly lower risk than those treated with RT alone (RR = 0.45, 95% CI = 0.22 to 0.91). Breast cancer risk increased with increasing radiation dose among patients who received RT only (RR = 12.7, 95% CI = 1.8 to 86, for patients receiving у38.5 Gy) but not among patients treated with CT and RT. Sixty-nine percent of control subjects treated with RT and more than six cycles of CT, but only 9% of those who received RT alone, reached menopause before age 41. Reaching menopause before age 36 was associated with a strongly reduced risk of breast cancer (RR = 0.06, 95% CI = 0.01 to 0.45). Conclusion: Breast cancer risk increases with increasing radiation dose up to at least 40 Gy. The substantial risk reduction associated with CT may reflect its effect on menopausal age, suggesting that ovarian hormones promote tumorigenesis after radiation has produced an initiating event. [
Radiotherapy and Oncology, 1996
Alberta Law Review
As oil and gas exploration activities are beginning to concentrate in offshore regions, it is ine... more As oil and gas exploration activities are beginning to concentrate in offshore regions, it is inevitable that two major problems will be encountered: (1) international boundaries; and (2) federal-provincial control over offshore resources. The authors devote the first part of their paper to discussion of the first problem. They analyze the historical origin of offshore rights; current international law on the subject; various methods of determining boundaries; followed by detailed examination of six of Canada's present boundary disputes and the corresponding position taken by the concerned countries in each case. The latter part of the paper is devoted to the federal-provincial issue, concentrating on constitutional aspects, resource sharing, and admin istration of the offshore operation. The authors critically analyze the Offshore Minerals Reference case, and proceed to comparative study between Canada, Australia, and the United States with respect to the control, development a...
Nederlands tijdschrift voor geneeskunde, Jan 15, 1986
Nederlands tijdschrift voor geneeskunde, Jan 25, 1991
In order to determine the population-based survival of patients with cancer and changes over time... more In order to determine the population-based survival of patients with cancer and changes over time, a follow-up study with the Eindhoven Cancer Registry was carried out in 11 hospitals in southeastern Noord Brabant and northern Limburg. Data were collected from medical records and supplemented with information on date of death as of 31 December, 1987, and the relative survival, the ratio of observed and expected survival and trends in age-specific cancer mortality were calculated. Of 22,833 patients diagnosed in the period 1975-85 22,744 could be evaluated; 22% were over 75 years of age and 13% did not receive primary treatment of the tumour. The 5 and 10-year cumulative relative survival rates were 33% and 27% for men and 51% and 44% for women, respectively. The 10-year relative survival rate was more than 50% for Hodgkin's disease, melanoma and cancer of the testis, breast, larynx, thyroid, uterine cervix and corpus; it was less than 20% for multiple myeloma, cancer of the oeso...
Nederlands tijdschrift voor geneeskunde, 2000
To analyse the incidence and treatment of ductal carcinoma in situ (DCIS) of the breast in the po... more To analyse the incidence and treatment of ductal carcinoma in situ (DCIS) of the breast in the population. Retrospective, descriptive. The incidence of DCIS in the period 1975-1997 in 8 hospitals in southeastern North Brabant and northern Limburg, the Netherlands, was analysed, using data from the Eindhoven Cancer Registry. Changes in the treatment of DCIS in the period 1984-1997 were studied, using information from the Breast Cancer Documentation Project. Between 1975 and 1997, 448 cases of DCIS were detected in 442 women. After adjustment for age according to the European Standard Population, the incidence rate of DCIS increased from 0.3 per 100,000 in 1975 to 13.4 in 1997. Of the 87 patients with DCIS between 50 and 69 years of age in 1996 and 1997, 68% was detected by the screening programme. The proportion of patients with DCIS undergoing ablation of the breast was 53% during the period 1984-1989, and varied around 45% thereafter. The other patients underwent local excision. Th...
Nederlands tijdschrift voor geneeskunde, 1998
To assess the effect of oestrogen (ER) and progesterone (PgR) receptors on the prognosis of patie... more To assess the effect of oestrogen (ER) and progesterone (PgR) receptors on the prognosis of patients with operable breast cancer and the decision to treat these patients with adjuvant tamoxifen. Retrospective. Eight community hospitals in the Southeast Netherlands. Using the registry of the Comprehensive Cancer Centre South, 2862 breast cancer patients were identified with stage I, II or IIIA tumours, treated during the period 1984-1992. ER and PgR status were known for 2393 (84%) and 1761 (62%) patients respectively. From 1991, over 80% of the postmenopausal, lymph node positive patients had received tamoxifen, irrespective of the steroid receptor status. Of all lymph node negative patients fewer than 3% received adjuvant systemic treatment. Among the lymph node negative patients the steroid receptor status was not a significant predictor of survival. Among the lymph node positive patients whose tumours were both ER-negative and PgR-negative, a 2.8-fold increased risk of death was ...
Nederlands tijdschrift voor geneeskunde, Jan 3, 1998
Mammary carcinoma was diagnosed in two women aged 31 and 38 years after they had been subjected t... more Mammary carcinoma was diagnosed in two women aged 31 and 38 years after they had been subjected to mantle irradiation for Hodgkin's disease at the ages of 17 and 20 years, respectively. Breast amputation was performed in one case, lumpectomy in the other; the subsequent courses were uncomplicated. During follow-up there was no sign of recurrence. Lifelong follow-up by specialists of women irradiated for Hodgkin's disease should be considered; monthly self-examination of the breasts should be advised and mammography should be carried out annually as from 10 years after thoracic or axillary irradiation. It is especially women treated before their 20th year of life who run a relatively high risk.
British journal of cancer, 1998
We studied the incidence and survival rates for the histological subtypes of non-small-cell lung ... more We studied the incidence and survival rates for the histological subtypes of non-small-cell lung cancer, using data from the Eindhoven Cancer Registry over the period 1975-94. The proportions with adenocarcinoma and large-cell undifferentiated carcinoma increased from 11% to 21% and from 11% to 15%, respectively, while those with squamous cell carcinoma decreased from 78% to 62%. The increase in the proportion with adenocarcinoma was only found among men. Although the overall prognosis for patients with non-small-cell lung cancer has remained unchanged, there have been divergent changes between morphological subtypes. Relative 1- and 5-year survival rates for squamous cell carcinoma have improved slightly from 48% to 51% and from 14% to 16%, respectively, because of an increase in the proportion with localized tumours, while relative 1- and 5-year survival rates for adenocarcinoma have decreased from 59% to 45% and from 28% to 18%, respectively, because of a decrease in localized tu...
Annals of oncology : official journal of the European Society for Medical Oncology / ESMO, 1998
Cytotoxic therapy appears to have improved short-term survival for patients with small-cell lung ... more Cytotoxic therapy appears to have improved short-term survival for patients with small-cell lung cancer, but little is known about the results for unselected patients and trends in long-term survival. One thousand seven hundred ninety-six patients with small-cell lung cancer diagnosed between 1975 and 1994 in southeastern Netherlands. We studied treatment policy for and survival of unselected patients since 1975, when cytotoxic therapy emerged. The proportion patients receiving chemotherapy, with or without irradiation, almost tripled from 30% to 82% for patients younger than 70 years of age and from 15% to 56% for those over 70, whereas the proportion receiving only radiotherapy decreased from 36% to 5% in both age groups. The short-term (< 2 year) survival rate improved markedly between 1975 and 1989, especially for patients younger than 70 (median survival increased from five to 10 months). Two-year survival remained poor (8%). Two percent of all patients younger than 70 years...
British journal of cancer, 1994
Despite many new advances in breast cancer therapy since the 1970s, there are only few reports on... more Despite many new advances in breast cancer therapy since the 1970s, there are only few reports on improved prognosis in a general population. A follow-up of more than 10 years is rarely reported, and a differentiation according to stage of the disease or between follow-up intervals is seldom made. Our purpose was to assess whether prognosis of primary breast cancer improved in patients diagnosed between 1970 and 1984 in south-eastern Netherlands, and to distinguish between different stages and follow-up intervals. Data from 4,467 breast cancer patients diagnosed between 1970 and 1984 were derived from the population-based Eindhoven Cancer Registry. Follow-up was attained up to 1 July 1991. Relative survival rates, as the ratio of the observed to the expected rates, were calculated. In a multivariate analysis a change in prognosis over time was computed with adjustment for age and stage; this was done separately for 5 year follow-up intervals. The relative survival rates were 69% aft...
Bulletin du cancer. Radiothérapie : journal de la Société française du cancer : organe de la société française de radiothérapie oncologique, 1994
Between January 1974 and December 1988, 46 patients with cancer of the urinary bladder, stages T1... more Between January 1974 and December 1988, 46 patients with cancer of the urinary bladder, stages T1 or T2, and one patient with stage T3, were treated with an interstitial implant at the radiotherapy department of the Catharina Ziekenhuis at Eindhoven, The Netherlands. Prior to implantation, one patient received no external radiotherapy, all other 46 patients were treated by either a low dose (40 patients: 12 Gy median) or an intermediate dose (six patients: 38-40 Gy) of external radiotherapy. Loco-regional relapse was observed in 14/47 (30%) of the patients (1/14 also had distant metastases). The site of loco-regional relapse was the bladder in 11 patients and the immediate vicinity of the bladder in three patients. Only four patients died due to uncontrolled locoregional disease. A salvage cystectomy was performed in five patients. Distant metastases alone were observed in 3/47 (6.4%) of patients. The intercurrent death corrected actuarial 5 and 10-year survival was 79.5% (72.2% for...
Nederlands tijdschrift voor geneeskunde, Jan 11, 1989
Nederlands tijdschrift voor geneeskunde, Jan 14, 1990
Data on incidence, tumour size at diagnosis and mortality from breast cancer in the southeast of ... more Data on incidence, tumour size at diagnosis and mortality from breast cancer in the southeast of the Netherlands, collected by means of the SOOZ-cancer registry were studied in combination with data on patient management, collected through the regional tumour work group. Age-adjusted incidence increased by approx. 1% per year, especially in women less than 50 years and mortality showed a slight decrease in women less than 60 years. The proportion of patients with a tumour greater than 5 cm and with extension to chest wall or skin decreased from more than 40 to 15%. The proportion of tumours of 2.1-5 cm rose from 30 to 35% and that of less than or equal to 2 cm from 20 to almost 45%, in particular in younger women. The process of patient management changed by the shift to smaller tumours and the introduction of mammography, cytology and breast sparing treatment. These 'spontaneous' changes may have implications for the effectiveness of future breast cancer screening programs,...
The Netherlands journal of surgery, 1991
A total of 514 patients with malignant breast tumours (3 cm or less in diameter) and without evid... more A total of 514 patients with malignant breast tumours (3 cm or less in diameter) and without evidence of distant metastases underwent tumour excision, axillary dissection and radiotherapy in nine community hospitals in southeastern Netherlands and a regional institute for radiotherapy (1981-1987). Follow-up ranged from 16 to 109 months, mean 50 months. The five-year overall survival was 87 per cent and the breast cancer specific survival 90 per cent. The five-year disease-free survival was 78 per cent. The local recurrence rate was 4.4 per cent at five years and the regional recurrence rate 4.5 per cent. Survival and local recurrence rate were in accordance with the early results reported by leading centres. The regional recurrence rate seemed to be somewhat higher. This study indicates that patients with early breast cancer can be treated effectively and safely with breast-conserving therapy in community hospitals.
Nederlands tijdschrift voor geneeskunde, Jan 5, 1992
Trends in incidence, stage distribution and mortality of breast cancer were determined in the Sou... more Trends in incidence, stage distribution and mortality of breast cancer were determined in the Southeastern Netherlands in 1960-1989. First and second primary breast cancers were analyzed separately. The incidence and mortality rates were age-standardised according to the European Standard Population. The incidence rate of first primary invasive breast cancer increased from 50 per 100,000 women per year in 1960-61 to 96 in 1988-89, and of second primary invasive breast cancer from 3.2 in 1965-66 to 7.8 in 1988-89. The incidence rate of first primary ductal carcinoma in situ (DCIS) increased from 0.3 per 100,000 women per year in 1975-76 to 2.8 in 1988-89 and of second primary DCIS from 0.06 in 1975-79 to 0.4 per 100,000 in 1985-89. The increase in first invasive primaries was observed in all age groups, but mostly at age 75 and over. The percentage with stage I tumours of the patients with a first primary invasive breast cancer increased from 7% in the sixties to 27% in the eighties,...
JNCI Journal of the National Cancer Institute, 2003
Background: Female survivors of Hodgkin's disease (HD) have a strongly elevated risk of breast ca... more Background: Female survivors of Hodgkin's disease (HD) have a strongly elevated risk of breast cancer, but factors responsible for the increased risk are not well known. Methods: We investigated the effects of radiation dose, chemotherapy (CT), and reproductive factors on breast cancer risk in a nested case-control study in The Netherlands in a cohort of 770 female patients who had been diagnosed with HD before age 41. Detailed treatment information and data on reproductive factors were collected for 48 case patients who developed breast cancer 5 or more years after diagnosis of HD and 175 matched control subjects. The radiation dose was estimated to the area of the breast where the case patient's tumor had developed and to a comparable location in matched control subjects. Relative risks (RRs) of breast cancer were calculated by conditional logistic regression. Statistical tests were two-sided. Results: The risk of breast cancer increased statistically significantly with radiation dose (P trend = .01); patients who received 38.5 Gy or more had an RR of 4.5 (95% confidence interval [CI] = 1.3 to 16) times that of patients who received less than 4 Gy. Patients who received both CT and radiotherapy (RT) had a statistically significantly lower risk than those treated with RT alone (RR = 0.45, 95% CI = 0.22 to 0.91). Breast cancer risk increased with increasing radiation dose among patients who received RT only (RR = 12.7, 95% CI = 1.8 to 86, for patients receiving у38.5 Gy) but not among patients treated with CT and RT. Sixty-nine percent of control subjects treated with RT and more than six cycles of CT, but only 9% of those who received RT alone, reached menopause before age 41. Reaching menopause before age 36 was associated with a strongly reduced risk of breast cancer (RR = 0.06, 95% CI = 0.01 to 0.45). Conclusion: Breast cancer risk increases with increasing radiation dose up to at least 40 Gy. The substantial risk reduction associated with CT may reflect its effect on menopausal age, suggesting that ovarian hormones promote tumorigenesis after radiation has produced an initiating event. [
Radiotherapy and Oncology, 1996
Alberta Law Review
As oil and gas exploration activities are beginning to concentrate in offshore regions, it is ine... more As oil and gas exploration activities are beginning to concentrate in offshore regions, it is inevitable that two major problems will be encountered: (1) international boundaries; and (2) federal-provincial control over offshore resources. The authors devote the first part of their paper to discussion of the first problem. They analyze the historical origin of offshore rights; current international law on the subject; various methods of determining boundaries; followed by detailed examination of six of Canada's present boundary disputes and the corresponding position taken by the concerned countries in each case. The latter part of the paper is devoted to the federal-provincial issue, concentrating on constitutional aspects, resource sharing, and admin istration of the offshore operation. The authors critically analyze the Offshore Minerals Reference case, and proceed to comparative study between Canada, Australia, and the United States with respect to the control, development a...
Nederlands tijdschrift voor geneeskunde, Jan 15, 1986
Nederlands tijdschrift voor geneeskunde, Jan 25, 1991
In order to determine the population-based survival of patients with cancer and changes over time... more In order to determine the population-based survival of patients with cancer and changes over time, a follow-up study with the Eindhoven Cancer Registry was carried out in 11 hospitals in southeastern Noord Brabant and northern Limburg. Data were collected from medical records and supplemented with information on date of death as of 31 December, 1987, and the relative survival, the ratio of observed and expected survival and trends in age-specific cancer mortality were calculated. Of 22,833 patients diagnosed in the period 1975-85 22,744 could be evaluated; 22% were over 75 years of age and 13% did not receive primary treatment of the tumour. The 5 and 10-year cumulative relative survival rates were 33% and 27% for men and 51% and 44% for women, respectively. The 10-year relative survival rate was more than 50% for Hodgkin's disease, melanoma and cancer of the testis, breast, larynx, thyroid, uterine cervix and corpus; it was less than 20% for multiple myeloma, cancer of the oeso...
Nederlands tijdschrift voor geneeskunde, 2000
To analyse the incidence and treatment of ductal carcinoma in situ (DCIS) of the breast in the po... more To analyse the incidence and treatment of ductal carcinoma in situ (DCIS) of the breast in the population. Retrospective, descriptive. The incidence of DCIS in the period 1975-1997 in 8 hospitals in southeastern North Brabant and northern Limburg, the Netherlands, was analysed, using data from the Eindhoven Cancer Registry. Changes in the treatment of DCIS in the period 1984-1997 were studied, using information from the Breast Cancer Documentation Project. Between 1975 and 1997, 448 cases of DCIS were detected in 442 women. After adjustment for age according to the European Standard Population, the incidence rate of DCIS increased from 0.3 per 100,000 in 1975 to 13.4 in 1997. Of the 87 patients with DCIS between 50 and 69 years of age in 1996 and 1997, 68% was detected by the screening programme. The proportion of patients with DCIS undergoing ablation of the breast was 53% during the period 1984-1989, and varied around 45% thereafter. The other patients underwent local excision. Th...
Nederlands tijdschrift voor geneeskunde, 1998
To assess the effect of oestrogen (ER) and progesterone (PgR) receptors on the prognosis of patie... more To assess the effect of oestrogen (ER) and progesterone (PgR) receptors on the prognosis of patients with operable breast cancer and the decision to treat these patients with adjuvant tamoxifen. Retrospective. Eight community hospitals in the Southeast Netherlands. Using the registry of the Comprehensive Cancer Centre South, 2862 breast cancer patients were identified with stage I, II or IIIA tumours, treated during the period 1984-1992. ER and PgR status were known for 2393 (84%) and 1761 (62%) patients respectively. From 1991, over 80% of the postmenopausal, lymph node positive patients had received tamoxifen, irrespective of the steroid receptor status. Of all lymph node negative patients fewer than 3% received adjuvant systemic treatment. Among the lymph node negative patients the steroid receptor status was not a significant predictor of survival. Among the lymph node positive patients whose tumours were both ER-negative and PgR-negative, a 2.8-fold increased risk of death was ...
Nederlands tijdschrift voor geneeskunde, Jan 3, 1998
Mammary carcinoma was diagnosed in two women aged 31 and 38 years after they had been subjected t... more Mammary carcinoma was diagnosed in two women aged 31 and 38 years after they had been subjected to mantle irradiation for Hodgkin's disease at the ages of 17 and 20 years, respectively. Breast amputation was performed in one case, lumpectomy in the other; the subsequent courses were uncomplicated. During follow-up there was no sign of recurrence. Lifelong follow-up by specialists of women irradiated for Hodgkin's disease should be considered; monthly self-examination of the breasts should be advised and mammography should be carried out annually as from 10 years after thoracic or axillary irradiation. It is especially women treated before their 20th year of life who run a relatively high risk.
British journal of cancer, 1998
We studied the incidence and survival rates for the histological subtypes of non-small-cell lung ... more We studied the incidence and survival rates for the histological subtypes of non-small-cell lung cancer, using data from the Eindhoven Cancer Registry over the period 1975-94. The proportions with adenocarcinoma and large-cell undifferentiated carcinoma increased from 11% to 21% and from 11% to 15%, respectively, while those with squamous cell carcinoma decreased from 78% to 62%. The increase in the proportion with adenocarcinoma was only found among men. Although the overall prognosis for patients with non-small-cell lung cancer has remained unchanged, there have been divergent changes between morphological subtypes. Relative 1- and 5-year survival rates for squamous cell carcinoma have improved slightly from 48% to 51% and from 14% to 16%, respectively, because of an increase in the proportion with localized tumours, while relative 1- and 5-year survival rates for adenocarcinoma have decreased from 59% to 45% and from 28% to 18%, respectively, because of a decrease in localized tu...
Annals of oncology : official journal of the European Society for Medical Oncology / ESMO, 1998
Cytotoxic therapy appears to have improved short-term survival for patients with small-cell lung ... more Cytotoxic therapy appears to have improved short-term survival for patients with small-cell lung cancer, but little is known about the results for unselected patients and trends in long-term survival. One thousand seven hundred ninety-six patients with small-cell lung cancer diagnosed between 1975 and 1994 in southeastern Netherlands. We studied treatment policy for and survival of unselected patients since 1975, when cytotoxic therapy emerged. The proportion patients receiving chemotherapy, with or without irradiation, almost tripled from 30% to 82% for patients younger than 70 years of age and from 15% to 56% for those over 70, whereas the proportion receiving only radiotherapy decreased from 36% to 5% in both age groups. The short-term (< 2 year) survival rate improved markedly between 1975 and 1989, especially for patients younger than 70 (median survival increased from five to 10 months). Two-year survival remained poor (8%). Two percent of all patients younger than 70 years...
British journal of cancer, 1994
Despite many new advances in breast cancer therapy since the 1970s, there are only few reports on... more Despite many new advances in breast cancer therapy since the 1970s, there are only few reports on improved prognosis in a general population. A follow-up of more than 10 years is rarely reported, and a differentiation according to stage of the disease or between follow-up intervals is seldom made. Our purpose was to assess whether prognosis of primary breast cancer improved in patients diagnosed between 1970 and 1984 in south-eastern Netherlands, and to distinguish between different stages and follow-up intervals. Data from 4,467 breast cancer patients diagnosed between 1970 and 1984 were derived from the population-based Eindhoven Cancer Registry. Follow-up was attained up to 1 July 1991. Relative survival rates, as the ratio of the observed to the expected rates, were calculated. In a multivariate analysis a change in prognosis over time was computed with adjustment for age and stage; this was done separately for 5 year follow-up intervals. The relative survival rates were 69% aft...
Bulletin du cancer. Radiothérapie : journal de la Société française du cancer : organe de la société française de radiothérapie oncologique, 1994
Between January 1974 and December 1988, 46 patients with cancer of the urinary bladder, stages T1... more Between January 1974 and December 1988, 46 patients with cancer of the urinary bladder, stages T1 or T2, and one patient with stage T3, were treated with an interstitial implant at the radiotherapy department of the Catharina Ziekenhuis at Eindhoven, The Netherlands. Prior to implantation, one patient received no external radiotherapy, all other 46 patients were treated by either a low dose (40 patients: 12 Gy median) or an intermediate dose (six patients: 38-40 Gy) of external radiotherapy. Loco-regional relapse was observed in 14/47 (30%) of the patients (1/14 also had distant metastases). The site of loco-regional relapse was the bladder in 11 patients and the immediate vicinity of the bladder in three patients. Only four patients died due to uncontrolled locoregional disease. A salvage cystectomy was performed in five patients. Distant metastases alone were observed in 3/47 (6.4%) of patients. The intercurrent death corrected actuarial 5 and 10-year survival was 79.5% (72.2% for...
Nederlands tijdschrift voor geneeskunde, Jan 11, 1989
Nederlands tijdschrift voor geneeskunde, Jan 14, 1990
Data on incidence, tumour size at diagnosis and mortality from breast cancer in the southeast of ... more Data on incidence, tumour size at diagnosis and mortality from breast cancer in the southeast of the Netherlands, collected by means of the SOOZ-cancer registry were studied in combination with data on patient management, collected through the regional tumour work group. Age-adjusted incidence increased by approx. 1% per year, especially in women less than 50 years and mortality showed a slight decrease in women less than 60 years. The proportion of patients with a tumour greater than 5 cm and with extension to chest wall or skin decreased from more than 40 to 15%. The proportion of tumours of 2.1-5 cm rose from 30 to 35% and that of less than or equal to 2 cm from 20 to almost 45%, in particular in younger women. The process of patient management changed by the shift to smaller tumours and the introduction of mammography, cytology and breast sparing treatment. These 'spontaneous' changes may have implications for the effectiveness of future breast cancer screening programs,...
The Netherlands journal of surgery, 1991
A total of 514 patients with malignant breast tumours (3 cm or less in diameter) and without evid... more A total of 514 patients with malignant breast tumours (3 cm or less in diameter) and without evidence of distant metastases underwent tumour excision, axillary dissection and radiotherapy in nine community hospitals in southeastern Netherlands and a regional institute for radiotherapy (1981-1987). Follow-up ranged from 16 to 109 months, mean 50 months. The five-year overall survival was 87 per cent and the breast cancer specific survival 90 per cent. The five-year disease-free survival was 78 per cent. The local recurrence rate was 4.4 per cent at five years and the regional recurrence rate 4.5 per cent. Survival and local recurrence rate were in accordance with the early results reported by leading centres. The regional recurrence rate seemed to be somewhat higher. This study indicates that patients with early breast cancer can be treated effectively and safely with breast-conserving therapy in community hospitals.
Nederlands tijdschrift voor geneeskunde, Jan 5, 1992
Trends in incidence, stage distribution and mortality of breast cancer were determined in the Sou... more Trends in incidence, stage distribution and mortality of breast cancer were determined in the Southeastern Netherlands in 1960-1989. First and second primary breast cancers were analyzed separately. The incidence and mortality rates were age-standardised according to the European Standard Population. The incidence rate of first primary invasive breast cancer increased from 50 per 100,000 women per year in 1960-61 to 96 in 1988-89, and of second primary invasive breast cancer from 3.2 in 1965-66 to 7.8 in 1988-89. The incidence rate of first primary ductal carcinoma in situ (DCIS) increased from 0.3 per 100,000 women per year in 1975-76 to 2.8 in 1988-89 and of second primary DCIS from 0.06 in 1975-79 to 0.4 per 100,000 in 1985-89. The increase in first invasive primaries was observed in all age groups, but mostly at age 75 and over. The percentage with stage I tumours of the patients with a first primary invasive breast cancer increased from 7% in the sixties to 27% in the eighties,...