Ethnicity, deprivation and screening: survival from breast cancer among screening-eligible women in the West Midlands diagnosed from 1989 to 2011

Abstract

Background:Social inequalities in breast cancer survival are smaller when the cancer is screen-detected. We examined survival from screen-detected and non screen-detected breast cancer by ethnicity and deprivation.Methods:Cancer registry data for 20 283 women aged 50–70 years, diagnosed between 1989–2011 and invited for screening, were linked with screening and ethnicity data. We examined Asian, Black and White groups, less deprived and middle/more deprived women. Net survival was estimated using ethnic- and deprivation-specific life tables. Estimates were corrected for lead-time bias and over-diagnosis.Results:Net survival varied by screening history. No significant differences in survival were found by ethnicity. Five-year net survival was 90.0% (95% CI, 89.3–90.8%) in less deprived groups and 86.7% (85.9–87.4%) among middle/more deprived women. Screening benefitted all ethnic and both deprivation groups. Whether screen-detected or not, more deprived women had significantly poorer outcomes: 5-year net survival was 78.0% (76.7–79.2%) for deprived women who were not screen-detected compared with 94.0% (93.1–95.1%) for less deprived women who were screen-detected.Conclusions:The three ethnic groups differed little in their breast cancer survival. Although screening confers a survival benefit to all, there are still wide disparities in survival by deprivation. More needs to be done to determine what underlies these differences and tackle them.

No ‘cure’ within 12 years of diagnosis among breast cancer patients who are diagnosed via mammographic screening: women diagnosed in the West Midlands region of England 1989–2011

“…In particular, data such as these question whether a woman diagnosed once with breast cancer can be considered to be disease-free, and increases the importance of using the correct language when communicating with those who have previously been treated for breast cancer [29, 30]. Second, since the pattern is consistent for both screen-detected and non-screen-detected women, our data suggest that screening does not afford protection from long-term excess mortality, even though it is associated with an important and significant survival advantage at all times since diagnosis, independent of lead-time bias [13]. Communication of this important and unique feature of breast cancer to those women considering screening and diagnosed via screening should also be carefully considered.…”

“…Only those who had been continuously eligible for screening from the age of 50 onwards were included (described in detail elsewhere [13]). Cancer registry data on these individuals were obtained from the West Midlands Cancer Intelligence Unit and Breast Screening Quality Assurance Reference Centre [14].…”

“…Our approach for deriving ethnicity information for this cohort has been described [13]. Briefly, data on each woman's ethnicity were gathered from self-reports given on admittance to hospital (from HES data, 83% of women), or where this was missing, on presentation for breast screening (from NBSS data, 7%).…”

What might explain deprivation-specific differences in the excess hazard of breast cancer death amongst screen-detected women? Analysis of patients diagnosed in the West Midlands region of England from 1989 to 2011

“…In the UK, deprived women have lower breast cancer survival [1–5]. This has also been found to be the case in other countries [6–9].…”

“…We have previously examined this cohort 20, 265 women diagnosed in the West Midlands region of England from 1989 to 2011 [5]. We reported higher breast cancer survival in less deprived women amongst both women whose cancer was detected following symptoms, as well as amongst women whose tumor was screen-detected, and thus likely to be asymptomatic.…”