Poorer women less likely to survive breast cancer

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‘The Second All Breast Cancer Report’ is the first in-depth analysis in the UK to look at how the impact of treatment and route of diagnosis – either through screening or symptoms presented to a GP – affects the chance of surviving the disease (Note 1), among people with different levels of poverty (Note 2).

This gap could, in part, explain why England’s breast cancer survival rates are lower than in some other countries. Poorer women are being diagnosed with more advanced stage tumours which are detected too late for surgery or need more aggressive treatment.

For women presenting with symptoms of breast cancer, the report found a 15 per cent difference between the most (68 per cent) and least (83 per cent) deprived in those women who survive for more than five years (Note 3).

But there was very little difference in survival between the most and least deprived women who were diagnosed through screening.

Gill Lawrence, director of the West Midlands Cancer Intelligence Unit and report author, said: “These figures show that even though a greater number of affluent women develop breast cancer every year, poorer women are more likely to die from the disease. Not going for screening and delays in going to the doctor mean that less affluent women are being diagnosed with later stage cancers which need more invasive surgery and are far less likely to be treated with breast conserving surgery.

“But, if these women attend screening, are breast aware and go to their doctor as soon as they notice anything unusual for them such as a lump or changes to the nipple like a rash or dimpling there’s no reason why poorer women shouldn’t have the same chance of survival as more affluent women.”

Martin Lee, chair of the National Cancer Intelligence Network breast clinical reference group and consultant surgeon at University Hospitals Coventry and Warwickshire NHS Trust, said: “Having a more advanced breast cancer at diagnosis is a double blow, as more aggressive treatments are needed, and the outlook is worse.

“I know from my own experience with patients that they find it more distressing to cope with the diagnosis if they need both mastectomy and chemotherapy. Fortunately breast screening with mammograms is finding earlier stage cancers that can be controlled by less radical treatments and have better survival; it is particularly encouraging to see that this is narrowing the gap in outcomes between affluent and deprived women.”

Notes

1. Relative survival analyses were undertaken on 39,879 women diagnosed with invasive/micro-invasive breast cancer in the UK between 1st April 2002 and 31st March 2003 and compared with 44,069 women diagnosed between 1st January 2007 and 31 December 2007. These analyses allow the underlying background mortality to be taken into account.
2. Deprivation is calculated using the national Index of Multiple Deprivation which combines a number of indicators coving a range of economic, social and housing issues into a single score for each small area. Deprivation scores can be grouped into 5 ranges (quintiles), each containing one fifth of the population. Postcodes at diagnosis were used to allocate patients to their deprivation quintile.
3. 5-year relative survival for least deprived women diagnosed in 2002/2003 was 83% compared with 68% for the most deprived women, for those women presenting with symptoms of breast cancer. For those women diagnosed through screening, the 5-year survival figures were 94% for the most deprived group compared with 99% in the least deprived group, but this difference was not statistically different. Comparisons of 1 year survival rates in 2002/03 versus 2007 show that survival is improving (94% versus 96%). Overall 5 year survival rates for women diagnosed through the screening programme was 97% compared with 77% for those presenting symptomatically.

Reference

1. The Second All Breast Cancer Report, National Cancer Intelligence Network (2011)

klíčová slova: breast cancer, socioeconomic conditions