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Peer-reviewedCC BY-NC-NDESMO real world data and digital oncology

Standardisation of stage information collected by European population-based cancer registries: an application to breast cancer survival

  • S. Rossi1
  • F. Cerza1
  • D. Bennett2
  • K. Innos3
  • K. Henau4
  • E. Demuru1
  • L. Botta5
  • K. Hammas6
  • C. Vener7
  • R. Lillini8
  • A. Bernasconi5
  • A. Trama5
1 more authors
  • R. De Angelis1
8 affiliations
  1. 1Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
  2. 2Northern Ireland Cancer Registry, Centre for Public Health, Department of Epidemiology and Public Health, Queen's University, Mulhouse Building, Belfast, Northern Ireland, UK
  3. 3National Institute for Health Development, Department of Epidemiology and Biostatistics—Tervise Arengu Instituut, Tallinn, Estonia
  4. 4Belgian Cancer Registry, Brussel, Belgium
  5. 5Evaluative Epidemiology and Innovative Translational Development Unit, Department of Translational, Epidemiological and Data Science Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
  6. 6Registre des cancers du Haut-Rhin, Groupe hospitalier de la région de Mulhouse et Sud-Alsace (GHRMSA), France
  7. 7Epidemiology and Prevention Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
  8. 8Biostatistics, Bioinformatic and Data Science Unit, Department of Translational, Epidemiological, and Data Science Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Abstract

Background

Stage at diagnosis strongly influences breast cancer (BC) prognosis. However, differences in staging systems and incomplete data in European population-based cancer registries (PBCRs) limit international comparisons. We propose a standardized TNM-based stage reconstruction to analyse long-term stage-specific BC survival across Europe.Materials and methods

We analysed 714 864 female BC cases diagnosed during 2001-2013 from 23 PBCRs in 14 European countries from the EUROCARE-6 dataset. Stage data were standardized to the seventh TNM edition. Stage was reconstructed into four categories (I-IV). Ten-year relative survival (RS) and 10-year RS conditional on surviving 5 years (CRS10/5) were estimated in the period 2010-2014 using period analysis.Results

Availability of stage information for BC ranged from 75% to 99% across countries. Early-stage disease (I-II) represented 80% of known stages, with higher prevalence of stage I in Northern and Central Europe than in Eastern Europe. Overall, 10-year age-adjusted RS decreased from 97% in stage I to 10% in stage IV. Geographic variation was limited for stage I and marked for other stages, with poorer outcomes in Eastern Europe. CRS10/5 showed minimal excess mortality after 5 years for stage I but persistent excess mortality for more advanced stages. Younger women had poorer outcomes than those aged 45-54 years.Conclusions

Population-based data on stage for BC confirm the importance of early diagnosis and highlight large disparities in treatment and prognosis across Europe for patients with advanced-stage BC. Improved availability of harmonized stage information at population level is essential for designing and assessing evidence-based cancer control policies.

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Cite

BibTeXRIS
BibTeX
@article{rossi2026standardisation,
  title = {{Standardisation of stage information collected by European population-based cancer registries: an application to breast cancer survival}},
  author = {S. Rossi and F. Cerza and D. Bennett and K. Innos and K. Henau and E. Demuru and L. Botta and K. Hammas and C. Vener and R. Lillini and A. Bernasconi and A. Trama and R. De Angelis},
  journal = {ESMO real world data and digital oncology},
  year = {2026},
  month = oct,
  doi = {10.1016/j.esmorw.2026.100794},
  url = {https://europepmc.org/article/PMC/PMC13717890},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Standardisation of stage information collected by European population-based cancer registries: an application to breast cancer survival
AU  - S. Rossi
AU  - F. Cerza
AU  - D. Bennett
AU  - K. Innos
AU  - K. Henau
AU  - E. Demuru
AU  - L. Botta
AU  - K. Hammas
AU  - C. Vener
AU  - R. Lillini
AU  - A. Bernasconi
AU  - A. Trama
AU  - R. De Angelis
PY  - 2026
DA  - 2026/10/20
JO  - ESMO real world data and digital oncology
DO  - 10.1016/j.esmorw.2026.100794
UR  - https://europepmc.org/article/PMC/PMC13717890
AB  - Background  Stage at diagnosis strongly influences breast cancer (BC) prognosis. However, differences in staging systems and incomplete data in European population-based cancer registries (PBCRs) limit international comparisons. We propose a standardized TNM-based stage reconstruction to analyse long-term stage-specific BC survival across Europe.Materials and methods  We analysed 714 864 female BC cases diagnosed during 2001-2013 from 23 PBCRs in 14 European countries from the EUROCARE-6 dataset. Stage data were standardized to the seventh TNM edition. Stage was reconstructed into four categories (I-IV). Ten-year relative survival (RS) and 10-year RS conditional on surviving 5 years (CRS10/5) were estimated in the period 2010-2014 using period analysis.Results  Availability of stage information for BC ranged from 75% to 99% across countries. Early-stage disease (I-II) represented 80% of known stages, with higher prevalence of stage I in Northern and Central Europe than in Eastern Europe. Overall, 10-year age-adjusted RS decreased from 97% in stage I to 10% in stage IV. Geographic variation was limited for stage I and marked for other stages, with poorer outcomes in Eastern Europe. CRS10/5 showed minimal excess mortality after 5 years for stage I but persistent excess mortality for more advanced stages. Younger women had poorer outcomes than those aged 45-54 years.Conclusions  Population-based data on stage for BC confirm the importance of early diagnosis and highlight large disparities in treatment and prognosis across Europe for patients with advanced-stage BC. Improved availability of harmonized stage information at population level is essential for designing and assessing evidence-based cancer control policies.
SN  - 2949-8201
ER  -