The role of molecular, clinical and socioeconomic factors in the long-term survival of axillary node negative breast cancer patients

The overall objective of this study was to investigate factors associated with long-term survival in axillary node negative (ANN) breast cancer patients. Clinical and biological factors included stage, histopathologic grade, p53 mutation, Her-2/neu amplification, estrogen receptor status (ER), progesterone receptor status (PR) and vascular invasion. Census derived socioeconomic (SES) indicators included median individual and household income, proportions of university educated individuals, housing type, "incidence" of low income and an indicator of living in an affluent neighbourhood. The effects of these measures on breast cancer-specific survival and competing cause survival were investigated. A cohort study examining survival among axillary node negative (ANN) breast cancer patients in the greater Toronto area commenced in 1 989. Patients were followed up until death, lost-to-follow up or study termination in 2004. Data were collected from several sources measuring patient demographics, clinical factors, treatment, recurrence of disease and survival. Census level SES data were collected using census geo-coding of patient addresses' at the time of diagnosis. Additional survival data were acquired from the Ontario Cancer Registry to enhance and extend the observation period of the study. Survival patterns were examined using KaplanMeier and life table procedures. Associations were examined using log-rank and Wilcoxon tests of univariate significance. Multivariate survival analyses were perfonned using Cox proportional hazards models. Analyses were stratified into less than and greater than 5 year survival periods to observe whether known markers of short-tenn survival were also associated with reductions in long-tenn survival among breast cancer patients. The 15 year survival probabilities in this cohort were: for breast cancerspecific survival 0.88, competing causes survival 0.89 and for overall survival 0.78. Estrogen receptor (ER) and progesterone receptor (PR) status (Hazard Ratio (HR) ERIPR- versus ER+/PR+, 8.15,95% CI, 4.74, 14.00), p53 mutation (HR, 3.88, 95% CI, 2.00, 7.53) and Her-2 amplification (HR, 2.66, 95% CI, 1.36, 5.19) were associated with significant reductions in short-tenn breast cancer-specific survival «5 years following diagnosis), however, not with long-term survival in univariate analyses. Stage, histopathologic grade and ERiPR status were the clinicallbiologieal factors that were associated with short-term breast cancer specific survival in multivariate results. Living in an affluent neighbourhood (top quintile of median household income compared to the rest of the population) was associated with the largest significant increase in long-tenn breast cancer-specific survival after adjustment for stage, histopathologic grade and treatment (HR, 0.36, 95% CI, 0.12, 0.89).

Office of the City Clerk, St. Catharines Records, 1928-1974, n.d.

The site of present-day St. Catharines was settled by 3000 United Empire Loyalists at the end of the 18th century. From 1790, the settlement (then known as "The Twelve") grew as an agricultural community. St. Catharines was once referred to Shipman's Corners after Paul Shipman, owner of a tavern that was an important stagecoach transfer point. In 1815, leading businessman William Hamilton Merritt abandoned his wharf at Queenston and set up another at Shipman's Corners. He became involved in the construction and operation of several lumber and gristmills along Twelve Mile Creek. Shipman's Corners soon became the principal milling site of the eastern Niagara Peninsula. At about the same time, Merritt began to develop the salt springs that were discovered along the river which subsequently gave the village a reputation as a health resort. By this time St. Catharines was the official name of the village; the origin of the name remains obscure, but is thought to be named after Catharine Askin Robertson Hamilton, wife of the Hon. Robert Hamilton, a prominent businessman. Merritt devised a canal scheme from Lake Erie to Lake Ontario that would provide a more reliable water supply for the mills while at the same time function as a canal. He formed the Welland Canal Company, and construction took place from 1824 to 1829. The canal and the mills made St. Catharines the most important industrial centre in Niagara. By 1845, St. Catharines was incorporated as a town, with the town limits extending in 1854. Administrative and political functions were added to St. Catharines in 1862 when it became the county seat of Lincoln. In 1871, construction began on the third Welland Canal, which attracted additional population to the town. As a consequence of continual growth, the town limits were again extended. St. Catharines attained city status in 1876 with its larger population and area. Manufacturing became increasingly important in St. Catharines in the early 1900s with the abundance of hydro-electric power, and its location on important land and water routes. The large increase in population after the 1900s was mainly due to the continued industrialization and urbanization of the northern part of the city and the related expansion of business activity. The fourth Welland Canal was opened in 1932 as the third canal could no longer accommodate the larger ships. The post war years and the automobile brought great change to the urban form of St. Catharines. St. Catharines began to spread its boundaries in all directions with land being added five times during the 1950s. The Town of Merritton, Village of Port Dalhousie and Grantham Township were all incorporated as part of St. Catharines in 1961. In 1970 the Province of Ontario implemented a regional approach to deal with such issues as planning, pollution, transportation and services. As a result, Louth Township on the west side of the city was amalgamated, extending the city's boundary to Fifteen Mile Creek. With its current population of 131,989, St. Catharines has become the dominant centre of the Niagara region. Source: City of St. Catharines website http://www.stcatharines.ca/en/governin/HistoryOfTheCity.asp (January 27, 2011)