Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark

Abstract

Background To investigate how socioeconomic position (SEP) influences the effectiveness of cancer-directed treatment in premenopausal breast cancer patients in terms of breast cancer recurrence and mortality. Methods We conducted a cohort study nested in the ProBeCaRe (Predictors of Breast Cancer Recurrence) cohort (n = 5959). We identified all premenopausal women aged 18–55 years diagnosed with non-metastatic breast cancer and prescribed docetaxel-based chemotherapy in Denmark during 2007–2011. Population-based administrative registries provided data on SEP: marital status (married including registered partnership or single including divorced or widowed), cohabitation (cohabiting or living alone), education (low, intermediate, or high), income (low, medium, or high), and employment status (employed, unemployed, or health-related absenteeism). For each SEP measure, we computed incidence rates, cumulative incidence proportions (CIPs), and used Poisson regression to compute incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of recurrence and death. We stratified on estrogen receptor (ER) status/tamoxifen to evaluate interaction. Results Our study cohort included 2616 women; 286 (CIP 13%) experienced recurrence and 223 (CIP 11%) died during follow-up (median 6.6 and 7.2 years, respectively). Single women had both increased 5-year risks of recurrence (IRR 1.45, 95% CI 1.11–1.89) and mortality (IRR 1.83, 95% CI 1.32–2.52). Furthermore, we observed increased 5-year mortality in women with low education (IRR 1.49, 95% CI 0.95–2.33), low income (IRR 1.37, 95% CI 0.83–2.28), unemployment (IRR 1.61, 95% CI 0.83–3.13), or health-related work absenteeism (IRR 1.80, 95% CI 1.14–2.82), but smaller or no increased risk of recurrence. These findings were especially evident among women with ER+ tumors prescribed tamoxifen. Overall analyses (follow-up max. 10 years) provided similar results. Conclusions Low SEP in premenopausal women with non-metastatic breast cancer was associated with increased mortality, but not always recurrence. This suggests underdetection of recurrences in certain groups. Poor prognosis in women with low SEP, especially single women, may partly be explained by tamoxifen adherence.

Survival analysis of recurrent breast cancer patients using mix Bayesian network

“…Despite the aforementioned conclusion being given in the analysis conducted within this study, an inspection of the education-related graph shown in the study ( Fig. 1 ) reveals that there is no statistically significant disparity in the mortality risk among patients with varying levels of education [ 39 ]. Based on this, it seems that additional studies are important to identify the effect of education level on recurrence, survival and mortality of relapsed patients.…”

Determining prognostic factors and optimal surgical intervention for early-onset triple-negative breast cancer

“…influence treatment compliance, particularly among women experiencing side effects (36). Previous studies also showed that uninsured premenopausal patients are more likely to forgo effective treatment for financial reasons and to opt out of follow-up programs, causing recurrences to remain underdetected (36,37). According to SEER data, the rate of BCT between 2000 and 2006 in the United States was 55-60% (38).…”

“…Unmarried women are reportedly more likely to develop advanced-stage breast cancer, as having a spouse may represent a factor supporting the early detection of malignancy ( 34 , 35 ). Social support from a partner might also influence treatment compliance, particularly among women experiencing side effects ( 36 ). Previous studies also showed that uninsured premenopausal patients are more likely to forgo effective treatment for financial reasons and to opt out of follow-up programs, causing recurrences to remain under-detected ( 36 , 37 ).…”

“…Social support from a partner might also influence treatment compliance, particularly among women experiencing side effects ( 36 ). Previous studies also showed that uninsured premenopausal patients are more likely to forgo effective treatment for financial reasons and to opt out of follow-up programs, causing recurrences to remain under-detected ( 36 , 37 ).…”

Single-nucleotide polymorphisms and the effectiveness of taxane-based chemotherapy in premenopausal breast cancer: a population-based cohort study in Denmark

“…Advances in breast cancer diagnosis and increasingly effective treatments (including the introduction of taxanes) have enlarged the pool of breast cancer survivors [ 3 – 5 ]. Still, mortality measured up to 15 years after premenopausal breast cancer ranges from 11 to 14% in high-income countries [ 2 , 6 ]. Reasons for variation in individual treatment effectiveness are likely multifactorial.…”