Do pre-diagnosis primary care consultation patterns explain deprivation-specific differences in net survival among women with breast cancer? An examination of individually-linked data from the UK West Midlands cancer registry, national screening programme and Clinical Practice Research Datalink

Abstract

BackgroundIn England and Wales breast cancer survival is higher among more affluent women. Our aim was to investigate the potential of pre-diagnostic factors for explaining deprivation-related differences in survival.MethodsIndividually-linked data from women aged 50–70 in the West Midlands region of England, diagnosed with breast cancer 1989–2006 and continuously eligible for screening, was retrieved from the cancer registry, screening service and Clinical Practice Research Datalink. Follow-up was to the end of July 2012. Deprivation was measured at small area level, based on the quintiles of the income domain of the English indices of deprivation. Consultation rates per woman per week, time from last breast-related GP consultation to diagnosis, and from diagnosis to first surgery were calculated. We estimated net survival using the non-parametric Pohar-Perme estimator.ResultsThe rate of primary care consultations was similar during the 18 months prior to diagnosis in each deprivation group for breast and non-breast symptoms. Survival was lower for more deprived women from 4 years after diagnosis. Lower net survival was associated with more advanced extent of disease and being non-screen-detected. There was a persistent trend of lower net survival for more deprived women, irrespective of the woman’s obesity, alcohol, smoking or comorbidity status. There was no significant variation in time from last breast symptom to diagnosis by deprivation. However, women in more deprived categories experienced significantly longer periods between cancer diagnosis and first surgery (mean = 21.5 vs. 28.4 days, p = 0.03). Those whose surgery occurred more than 12 weeks following their cancer diagnosis had substantially lower net survival.ConclusionsOur data suggest that although more deprived women with breast cancer display lifestyle factors associated with poorer outcomes, their consultation frequency, comorbidities and the breast cancer symptoms they present with are similar. We found weak evidence of extended times to surgical treatment among most deprived women who were not screen-detected but who presented with symptoms in primary care, which suggests that treatment delay may play a role. Further investigation of interrelationships between these variables within a larger dataset is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3129-4) contains supplementary material, which is available to authorized users.

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“…For example, the background consultation rate in primary care of patients with cancer does not differ between routes to cancer diagnosis (emergency presentation or not). 61 62 In contrast, interventions on healthcare system factors might have a large impact on cancer survival, as shown by the recent changes in the management of patients with lung cancer. 43 However, such interventions have not influenced the socioeconomic inequalities in cancer survival yet, possibly because they do not directly address the differential interactions between the healthcare system and the patients, which could lead to suboptimal management of subgroups of the population.…”

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“…The presence of factors measured in primary health care, such as the presence of other diseases, obesity, smoking history, alcohol consumption, as well as the total number of consultations attended by the patient may also be associated with these inequalities. However, their role in explaining survival differentials has not been considered outside our own analysis of screening-eligible women diagnosed with breast cancer [ 20 , 21 ].…”

Identifying Methylation Pattern and Genes Associated with Breast Cancer Subtypes

“…According to epidemiological statistics provided by the World Health Organization in 2015, more than 8.8 million deaths, accounting for one in six deaths, are attributed to cancer [1]. Cancer has become one of the major threats to human health.…”

“…Among different cancer sites from different tissues and organs of the human body, breast cancer is one of the most common in women, with more than 1.7 million new cases recorded in 2012, accounting for one in four new cancer cases among all female cancers worldwide [2,3]. This disease has also been identified as one of the top five common causes of deaths, generating more than 0.57 million deaths in 2015 [1]. Therefore, breast cancer is widely regarded as a severe disease for humans worldwide, especially for women.…”