Socioeconomic inequalities in breast cancer incidence and mortality in Europe—a systematic review and meta-analysis

Abstract

Background: Breast cancer is the leading cause of female cancer in Europe and is estimated to affect more than one in 10 women. Higher socioeconomic status has been linked to higher incidence but lower case fatality, while the impact on mortality is ambiguous. Methods: We performed a systematic literature review and meta-analysis on studies on association between socioeconomic status and breast cancer outcomes in Europe, with a focus on effects of confounding factors. Summary relative risks (SRRs) were calculated. Results: The systematic review included 25 articles of which 8 studied incidence, 10 case fatality and 8 mortality. The meta-analysis showed a significantly increased incidence (SRR 1.25, 1.17–1.32), a significantly decreased case fatality (SRR 0.72, 0.63–0.81) and a significantly increased mortality (SRR 1.16, 1.10–1.23) for women with higher socioeconomic status. The association for incidence became insignificant when reproductive factors were included. Case fatality remained significant after controlling for tumour characteristics, treatment factors, comorbidity and lifestyle factors. Mortality remained significant after controlling for reproductive factors. Conclusion: Women with higher socioeconomic status show significantly higher breast cancer incidence, which may be explained by reproductive factors, mammography screening, hormone replacement therapy and lifestyle factors. Lower case fatality for women with higher socioeconomic status may be partly explained by differences in tumour characteristics, treatment factors, comorbidity and lifestyle factors. Several factors linked to breast cancer risk and outcome, such as lower screening attendance for women with lower socioeconomic status, are suitable targets for policy intervention aimed at reducing socioeconomic-related inequalities in health outcomes.

A Spatial and Temporal Analysis of the Socioeconomic Factors Associated with Breast Cancer in Illinois Using Geographically Weighted Generalized Linear Regression

“…What is more important, revealed by the analysis, is that both low and high economic status could be associated with an elevated risk of breast cancer. Existing studies have suggested a positive association between high SES with the risk of breast cancer owing to the use of hormone therapy and lifestyle (Yu et al 2014;Palmer et al 2012;Akinyemiju et al 2015;Lundqvist et al 2016;Conroy et al 2017). Such association was also confirmed in this study.…”

“…Furthermore, the greater likelihood of alcoholic consumption in women with high SES may also lead to a high blood level of estrogen, which could contribute to the increase of breast cancer risk (EHBCCG 2011). More recently, Lundqvist et al (2016) conducted a systematic review and meta-analysis of studies on the association between breast cancer and SES in Europe. They found that women with higher SES tend to have significantly higher breast cancer incidence owing to factors such as hormone replacement therapy, mammography screening, reproduction, and lifestyle.…”

Disparities in Breast Cancer Characteristics in Mexico

“…The differences in stages at diagnosis are essentially due to disparities in health services availability, a highly prevalent situation in Latin America and other developing countries, but also already reported in the USA 15,16 , Europe 6,17 and other countries of the world. In fact, an analysis of GLOBOCAN statistics has been conducted, demonstrating that breast cancer-related mortality is directly associated with the Human Development Index 18 , with one of the reasons being late detection, aggravated by unavailability of best treatments.…”

“…In addition to late diagnosis, other breast cancer epidemiological particularities have been reported in our country, such as presentation at earlier stages than in developed countries, which entails a higher impact on national public health services since it primarily affects women at productive age 5 . On the other hand, significant differences have been reported even within developed countries in both detection and treatment of breast cancer owing to sociodemographic and economic factors, with a direct impact on mortality 6,7 . In developing countries, the gaps in detection and quality of care are broader than in developed countries, and Mexico is not an exception.…”

Breast cancer and exposure to aircraft, road, and railway-noise: a case–control study based on health insurance records

“…Another critical limitation was the lack of individual socioeconomic information for more than two-thirds of the study population. Breast cancer incidence increases with socioeconomic status (possibly due to reproductive factors associated with socioeconomic status such as age at first birth and parity) (33), and increasing socioeconomic status often provides increasing resources to select residential areas less exposed to traffic noise. This makes socioeconomic status an important potential confounder, as well as a surrogate for socioeconomic-related risk factors.…”