Impact of deprivation on breast cancer survival among women eligible for mammographic screening in the West Midlands (UK) and New South Wales (Australia): Women diagnosed 1997–2006

Abstract

Women diagnosed with breast cancer in the UK display marked differences in survival between categories defined by socio‐economic deprivation. Timeliness of diagnosis is one of the possible explanations for these patterns. Women whose cancer is screen‐detected are more likely to be diagnosed at an earlier stage. We examined deprivation and screening‐specific survival in order to evaluate the role of early diagnosis upon deprivation‐specific survival differences in the West Midlands (UK) and New South Wales (Australia). We estimated net survival for women aged 50–65 years at diagnosis and whom had been continuously eligible for screening from the age of 50. Records for 5,628 women in West Midlands (98.5% of those eligible, mean age at diagnosis 53.7 years) and 6,396 women in New South Wales (99.9% of those eligible, mean age at diagnosis 53.8 years). In New South Wales, survival was similar amongst affluent and deprived women, regardless of whether their cancer was screen‐detected or not. In the West Midlands, there were large and persistent differences in survival between affluent and deprived women. Deprivation differences were similar between the screen‐detected and non‐screen detected groups. These differences are unlikely to be solely explained by artefact, or by patient or tumour factors. Further investigations into the timeliness and appropriateness of the treatments received by women with breast cancer across the social spectrum in the UK are warranted.

Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study

“… 9 However, as stage specific survival tends to be lower in England, more advanced stage would explain only part of the international 54 55 56 57 and socioeconomic inequalities in cancer survival. 58 59 A higher proportion of patients are now receiving a diagnosis through Two Week Wait or GP referral while for some cancers there is a major decrease in emergency presentation. 60 Although stage distribution might have slightly moved towards earlier stages, the picture remains patchy and there was no evidence to suggest a narrowing of these gaps in survival.…”

Is lower symptom recognition associated with socioeconomic inequalities in help‐seeking for potential breast cancer symptoms?

“…Alternatively, the finding that lower SES is not associated with decreased likelihood of help‐seeking for rash and lump suggests that inequalities' could be explained by differences beyond those examined in the present study and further along the patient pathway. Previous evidence suggests that there are a vast array of factors including patient factors (comorbidity and treatment adherence) and healthcare system factors (eg, timeliness of treatment) that may impact on inequalities in breast cancer . For example, lower socioeconomic groups are more likely to have multiple health conditions, and multiple health conditions are associated with higher consultation rates .…”

“…Previous evidence suggests that there are a vast array of factors including patient factors (comorbidity and treatment adherence) and healthcare system factors (eg, timeliness of treatment) that may impact on inequalities in breast cancer. 35,36 For example, lower socioeconomic groups are more likely to have multiple health conditions, and multiple health conditions are associated with higher consultation rates. 37,38 Comorbidities may in turn lead to delays in diagnosis where the management of the existing condition is considered by the patient (and/ or doctor) as more important than the new symptom.…”

Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data

“…[3][4][5] Even though Australia has a universal health care system, socio-economic differences in cancer survival exist. [6][7][8] In 2010-2014, five-year relative survival for all cancers combined was lower for patients living in the most disadvantaged areas (55%), relative to the least disadvantaged areas (67%). [9] The largest gaps were found for cancers of the head and neck, colorectum, cervix, kidney, prostate as well as non-Hodgkin lymphoma.…”