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Season of diagnosis and prognosis in breast and prostate cancer

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Abstract

Background

Patients with breast or prostate cancer diagnosed during the summer season have been observed to have better survival. The extent to which this is due to biological and/or health care system related factors is unclear.

Methods

Using the Swedish Cancer Register and clinical databases, we analyzed overall survival by month of diagnosis among the incident cases of breast (n = 89,630) cancer and prostate (n = 72,375) cancer diagnosed from 1960 to 2004. We retrieved data on tumor stage from 1976 for breast cancer and 1997 for prostate cancer. Cox proportional hazards models were used to calculate relative risk of survival by the season of diagnosis.

Results

There was a higher hazard ratio of death in men and women diagnosed with cancer in the summer with a relative hazard of 1.20 (95% confidence interval 1.15–1.25) for July for prostate cancer and 1.14 (95% confidence interval 1.09–1.19) for August for breast cancer when compared to being diagnosed in January. This difference coincided with a lower mean number of cases diagnosed per day, and a higher proportion of advanced cases diagnosed in the summer. This pattern of presentation was stronger in the later years.

Conclusion

The difference in stage distribution explains the seasonal variation in prognosis seen in this study. The variation may be because of structure of the health care system and a strong tradition of vacationing from mid June to mid August. Thus, the health care infrastructure and the late presentation of symptomatic disease may influence cancer survival studied by season of diagnosis substantially.

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Acknowledgment

The study was supported by the Swedish Cancer Society. The clinical databases were collected and quality assured by the regional working collaborative groups for breast and prostate cancer in the Stockholm–Gotland and the Uppsala–Örebro health care regions.

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Authors and Affiliations

  1. Regional Oncologic Center and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

    Lars Holmberg & Hans Garmo

  2. Division of Cancer Studies, Medical School, King’s College London, London, UK

    Lars Holmberg, Hans Garmo & Henrik Möller

  3. Oncologic Center, CLINTEC, Karolinska Institute, Stockholm, Sweden

    Jan Adolfsson

  4. Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Lorelei Mucci & Meir Stampfer

  5. Department of Epidemiology, Harvard School of Public Health, Boston, US

    Lorelei Mucci, Hans Olov Adami & Meir Stampfer

  6. Center for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden

    Jan-Erik Johansson

Authors
  1. Lars Holmberg
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  2. Jan Adolfsson
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  3. Lorelei Mucci
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  4. Hans Garmo
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  5. Hans Olov Adami
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  6. Henrik Möller
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  7. Jan-Erik Johansson
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  8. Meir Stampfer
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Corresponding author

Correspondence to Lars Holmberg.

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Holmberg, L., Adolfsson, J., Mucci, L. et al. Season of diagnosis and prognosis in breast and prostate cancer. Cancer Causes Control 20, 663–670 (2009). https://doi.org/10.1007/s10552-008-9279-6

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  • DOI: https://doi.org/10.1007/s10552-008-9279-6

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