Social differences in breast cancer survival in relation to patient management within a National Health Care System (Sweden)

Abstract

Epidemiologic studies have shown that cancer survival is poorer in low compared with high socioeconomic groups. We investigated whether these differences were associated with disparities in tumour characteristics and management. This cohort study was based on 9,908 women aged 20–79 years at diagnosis with primary breast cancer identified in a Swedish population‐based clinical register. Information on socioeconomic standing was obtained from a social database. The 5‐year cause‐specific survival (CSS) and mortality hazard ratios (HR) were estimated by Cox proportional hazard models to assess differences in survival between socioeconomic groups while adjusting for diagnostic intensity, tumour characteristics and treatment. Following adjustment for age, year and stage at diagnosis, the risk of dying of breast cancer was 35% lower among women with high education compared with that of low education (HR = 0.65, 95% CI 0.53–0.80). When compared with women with high education, a lower percentage of women with low education had been investigated for proliferation (84 vs. 76%) or hormone receptor status (89 vs. 81%), had tumours ≤20 mm (68 vs. 64%), were treated at a main hospital (75 vs. 68%) and had received radiation treatment (80 vs. 67%) or chemotherapy (31 vs. 18%). However, these proportional differences could not explain the observed social gradient in survival. To minimize social differences in breast cancer survival, further research should address not only factors leading to inequities in management but also focus on patient factors such as health awareness, comorbidity burden and compliance to adjuvant treatment. © 2008 Wiley‐Liss, Inc.

Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. Nationwide population‐based study

“…This association has also been observed in Sweden, a country with a tax‐financed national health care system aiming to provide care on equal terms to all residents 3, 4, 5…”

Sobrevida por câncer de mama e iniquidade em saúde

“…In the USA, this association was also evidenced in both cohort studies 25,26 and clinical trials 27 . Major studies conducted in European countries, some with national registries of the entire population, have also shown better prognosis for breast cancer in women with higher socioeconomic status 28,29,30 . Finally, such association is also found in countries with lower development levels 31,32,33 .…”

A Review of Breast Cancer Care and Outcomes in Latin America

“…A number of studies from Latin American countries have been published showing an inverse correlation between late-stage diagnosis of breast cancer and survival [37, 40 -47]. Because the stage at diagnosis affects outcomes and consequently the burden of disease on societies, we looked at the proportion of women diagnosed in each stage (in countries where data were available) and compared it with data from Sweden-one of the countries with the best breast cancer outcomes, where less than 10% of breast cancer patients presented with stage III or IV at diagnosis [48]. In contrast, in Latin American countries such as Peru, Colombia, and Mexico, approximately 50% of detected breast cancer cases are in advanced stages (Table 3).…”