Relation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer

Carnon, Andrew; Ssemwogerere, A; Lamont, D. W.; Hole, David; Mallon, E.; George, W D; Gillis, Garry

doi:10.1136/bmj.309.6961.1054

Cited by 72 publications

(61 citation statements)

References 17 publications

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“…However, several studies have shown deprived women to have poorer survival from breast cancer. Previous work carried out by the authors (Macleod et al, 2000a) confirmed earlier research (Carnon et al, 1994;Schrijvers et al, 1995) in showing no relationship between deprivation and pathological prognostic factors in women with early breast cancer. In addition, we have shown (Macleod et al, 2000b) that the NHS delivered health care equitably to women with breast cancer who lived in affluent and deprived areas.…”

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confidence: 69%

Anxiety and support in breast cancer: is this different for affluent and deprived women? A questionnaire study

et al. 2004

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A postal questionnaire was sent to affluent and deprived women with breast cancer in order to compare psychosocial aspects of care with the purpose of understanding the balance of care and explaining why deprived women have poorer outcomes. Data were collected regarding reported sources of information, SF-36 scores and ongoing causes of anxiety. The results demonstrate that affluent women were more likely to have received information from their hospital specialist (94.8 vs 76.0%) and from a breast care nurse (70.1 vs 40.0%) than deprived women. They were also more likely to have received information from magazines (50.6 vs 33.0%), newspapers (45.5 vs 22.0%) and television news (45.5 vs 26.0%). Deprived women had poorer SF-36 scores than affluent women, and reported greater anxiety about money (12.2 vs 2.8%), other health problems (22.1 vs 8.2%) and family problems (17.5 vs 6.9%). Personal and professional support is clearly important for patients with breast cancer. Health professionals need to be aware of the greater psychological distress demonstrated by deprived women, even some years after diagnosis with breast cancer, and seek to address it. British Journal of Cancer (2004) There is a higher incidence of breast cancer in affluent women than in socioeconomically deprived women (Tomatis, 1990). However, several studies have shown deprived women to have poorer survival from breast cancer. Previous work carried out by the authors (Macleod et al, 2000a) confirmed earlier research (Carnon et al, 1994;Schrijvers et al, 1995) in showing no relationship between deprivation and pathological prognostic factors in women with early breast cancer. In addition, we have shown (Macleod et al, 2000b) that the NHS delivered health care equitably to women with breast cancer who lived in affluent and deprived areas. In particular, socioeconomic status did not affect breast surgery, radiotherapy or adjuvant treatments.The care of women with breast cancer is not, however, limited to surgical and oncological treatments but also includes provision of information and psychosocial care and support. Although breast cancer is largely treated in hospitals by specialist surgeons and oncologists (Gillis and Hole, 1996) women spend the majority of their time after diagnosis in the community. Our study has shown that there were greater numbers of consultations with general practitioners following diagnosis than before diagnosis for all women, but that the greatest number were for women living in deprived areas (Macleod et al, 2000b).The relationship between breast cancer outcomes and psychosocial factors is complex and several studies have shown a link between socioeconomic status and broader psychosocial issues. Social class has been shown to have an effect on psychiatric outcome at 12 months after mastectomy with women in lower social classes having the worst outcome (Dean, 1987). Other research has suggested that women with breast cancer from lower socioeconomic groups may be particularly receptive to interventions that will enhance the...

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confidence: 69%

Anxiety and support in breast cancer: is this different for affluent and deprived women? A questionnaire study

et al. 2004

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“…Part of this difference is explained by more oestrogen receptor (ER) negative tumours in deprived women, but no other pathological differences have been observed . Several other studies have looked at other pathological criteria as the reason for the persistent survival differences and they have all failed to demonstrate an association (Carnon et al, 1994;Macleod et al, 2000a;Brewster et al, 2001). Access to health services does not appear to be a factor; in fact, deprived women appear to use primary care resources more often than the more affluent (Macleod et al, 2000b).…”

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Does deprivation affect breast cancer management?

et al. 2005

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“…3 To date, the reasons for social disparities in breast cancer prognosis are far from being established. Possible explanations include differences in sector of care, 7,8 access to early diagnosis, stage at diagnosis, 9 tumor biology 10,11 such as estrogen receptor status, [10][11][12][13] grade 9,13,14 or histologic type 13 and access to optimal treatment. 10,13,15 However, despite the numerous publications on social or ethnical disparities in breast cancer outcome, we still do not know to which extent these factors explain social inequalities in breast cancer prognosis.…”

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Social class is an important and independent prognostic factor of breast cancer mortality

Bouchardy

Verkooijen

Fioretta

2006

Intl Journal of Cancer

121

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Reasons of the important impact of socioeconomic status on breast cancer prognosis are far from established. This study aims to evaluate and explain the social disparities in breast cancer survival in the Swiss canton of Geneva, where healthcare costs and life expectancy are among the highest in the world. This populationbased study included all 3,920 female residents of Geneva, who were diagnosed with invasive breast cancer before the age of 70 years between 1980 and 2000. Patients were divided into 4 socioeconomic groups, according to the woman's last occupation. We used Cox multivariate regression analysis to identify reasons for the socioeconomic inequalities in breast cancer survival. Compared to patients of high social class, those of low social class had an increased risk (unadjusted hazard ratio [HR] 2.4, 95% CI: 1.6-3.5) of dying as a result of breast cancer. These women were more often foreigners, less frequently had screen-detected cancer and were at more advanced stage at diagnosis. They less frequently underwent breast-conserving surgery, hormonal therapy, and chemotherapy, in particular, in case of axillary lymph node involvement. When adjusting for all these factors, patients of low social class still had a significantly increased risk of dying of breast cancer (HR 1.8, 95% CI: 1.2-2.6). Overmortality linked to low SES is only partly explained by delayed diagnosis, unfavorable tumor characteristics and suboptimal treatments. Other factors, not measured in this study, also could play a role. While waiting for the outcome of other researches, we should consider socioeconomic status as an independent prognostic factor and provide intensified support and surveillance to women of low social class. ' 2006 Wiley-Liss, Inc.Key words: breast carcinoma; socioeconomic status; incidence; mortality; survivalIn North America and Western Europe, breast cancer accounts for more than 30% of new cancer cases and for 25% of cancer deaths among women. Breast cancer mortality rates are now decreasing because of the widely generalized use of mammography screening and the improvement in treatment. 1 Besides stage, tumor characteristics and treatment, only few factors are recognized as independent prognostic factors. Socioeconomic status (SES) could be one of them.Breast cancer occurs more frequently in wealthy countries 2 and among women with high SES. 3 This is partly due to a higher prevalence of breast cancer risk factors, such as older age at first pregnancy, low parity, high-calorie intake, sedentary occupation and use of hormonal replacement therapy in women with high SES. [3][4][5] On the other hand, breast cancer survival is in general lower in less affluent countries 6 and in women with low income or educational level. 3

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Relation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer

Cited by 72 publications

References 17 publications

Anxiety and support in breast cancer: is this different for affluent and deprived women? A questionnaire study

Anxiety and support in breast cancer: is this different for affluent and deprived women? A questionnaire study

Does deprivation affect breast cancer management?

Social class is an important and independent prognostic factor of breast cancer mortality

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