Socioeconomic status and breast cancer in Denmark

Danø, Hella; Andersen, Otto; Ewertz, Marianne; Petersen, Jørgen Holm; Lynge, Elsebeth

doi:10.1093/ije/dyg049

Cited by 70 publications

(59 citation statements)

References 20 publications

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“…The social inequality at diagnosis observed in our study contrasts with the increasing risk for breast cancer with increasing education (Danø et al, 2003) and occupational group (Dano et al, 2004) in Denmark. It remains unclear whether the reason for the disparity by risk-group is delay in diagnosis or differing biology of cancers in the groups with less education and income compared with more advantaged groups.…”

Section: Discussioncontrasting

confidence: 99%

The relation between socioeconomic and demographic factors and tumour stage in women diagnosed with breast cancer in Denmark, 1983–1999

et al. 2006

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The authors investigated the association between socioeconomic position and stage of breast cancer at the time of diagnosis in a nationwide Danish study. All 28 765 women with a primary invasive breast cancer diagnosed between 1983 and 1999 were identified in a nationwide clinical database and information on socioeconomic variables was obtained from Statistics Denmark. The risk of being diagnosed with a high-risk breast cancer, that is size 420 mm, lymph-node positive, ductal histology/high histologic grade and hormone receptor negative, was analysed by multivariate logistic regression. The adjusted odds ratio (OR) for high-risk breast cancer was reduced with longer education with a 12% reduced risk (95% confidence interval (CI), 0.80,0.96) in women with higher education and increased with reduced disposable income (low income group: OR, 1.22; 95% CI, 1.10,1.34). There was an urbanrural gradient, with higher risk among rural women (OR 1.10; 95 % CI, 1.02, 1.18) and lower risk among women in the capital suburbs (OR, 0.85; 95% CI, 0.78, 0.93) and capital area (OR, 0.93; 95% CI, 0.84 -1.02). These factors were significant only for postmenopausal women, although similar patterns were observed among the premenopausal women, suggesting a subgroup of aggressive premenopausal breast cancers less influenced by socioeconomic factors. British Journal of Cancer (2006) Although affluent women have a higher incidence of breast cancer than socially deprived women, several studies using individual or area-based socioeconomic measures have shown that deprived women with breast cancer have poorer survival from disease (Carnon et al, 1994; Stavraky et al, 1996;Kravdal, 2000;Bradley et al, 2001;Thomson et al, 2001;Menvielle et al, 2005;Woods et al, 2005).Long-term prognosis of breast cancer patients strongly depends on stage of disease at the time of diagnosis and thus, social inequalities in tumour progression at the time of diagnosis which has been reported in several (Schrijvers et al, 1995;Catalano and Satariano, 1998 Further, a higher proportion of oestrogen receptor positive tumours among women with a higher socioeconomic position has been reported (Gordon, 1995;Twelves et al, 1998;Thomson et al, 2001); this could either be interpreted as a difference in time of diagnosis (Hellman, 1994;Zhu et al, 1997) or as a different distribution of high-risk and low-risk breast cancer types (Anderson et al, 2005) across socioeconomic groups.We investigated the relation between socioeconomic position and tumour progression as measured by high-risk vs low-risk breast cancers at the time of diagnosis, stratified by menopausal status in a large nation-wide population based cohort of 28 765 women diagnosed with breast cancer in Denmark between 1983 and 1999. MATERIALS AND METHODS Case ascertainmentThe study population consisted of all 31 770 women identified in the files of the Danish Breast Cancer Cooperative Group (DBCG) with a primary invasive breast cancer diagnosed between 1 January 1983 and 31 December 1999 and who were less than 70 ye...

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Section: Discussioncontrasting

confidence: 99%

The relation between socioeconomic and demographic factors and tumour stage in women diagnosed with breast cancer in Denmark, 1983–1999

et al. 2006

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“…MS is considered to be more frequent in populations of high socioeconomic status, 12 also believed to be afflicted by increased risk of breast cancer, 47,48 prostate cancer 49 and colon cancer. 50 A recent study found no evidence of a socioeconomic gradient in the occurrence of MS in the Danish population 51 and accordingly, we believe that uncontrolled confounding from factors related to socioeconomic status are unlikely to explain the observed cancer profile in MS patients.…”

Section: Discussionmentioning

confidence: 99%

Cancer risk among patients with multiple sclerosis: A population‐based register study

Nielsen

Rostgaard

Rasmussen

et al. 2005

Intl Journal of Cancer

122

144

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Cancer occurrence in patients with multiple sclerosis (MS) has been little studied, but associations with brain tumours, breast cancer, Hodgkin lymphoma and nasopharyngeal carcinoma have been suggested. We took advantage of population-based registers of MS and cancer to assess the risk of cancer following diagnosis of MS. Patients registered in the Danish Multiple Sclerosis Register were linked with the Danish Cancer Register to obtain information on cancer occurrence. The ratio of the observed to the number of expected cancers based on population-based incidence rates, i.e., the standardised incidence ratio (SIR), served as measure of the relative cancer risk. A database comprising all Danish women born after April 1, 1935, with information on all live-born children, was used in the analyses of breast cancer to adjust for reproductive factors.

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“…An important question is whether these relations are indirect, and due to changes in the prevalence of risk factors associated with education, but which we could not study. (2006) Unlike most causes of death, breast cancer mortality risks have often been higher among women of high socioeconomic status (Faggiano et al, 1997;Heck et al, 1997;Dano et al, 2003Dano et al, , 2004. Some studies, however, found no such association (Lund and Jacobsen, 1991;Faggiano et al, 1997).…”

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confidence: 99%

Social inequalities in breast cancer mortality among French women: disappearing educational disparities from 1968 to 1996

et al. 2005

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We investigated the time trends in social inequalities in breast cancer mortality with an analysis by age at death and birth cohort using a representative 1% sample of the French population and four subcohorts (1968 -1974, 1975 -1981, 1982 -1988 and 1990 -1996). Causes of death were obtained by direct linkage with the French national death registry. Education was measured at the beginning of each period, and educational disparities in breast cancer mortality were studied among women aged 35 -74 at the beginning of each period. In the 1970s, higher breast cancer mortality was found among higher educated women. This positive association progressively weakened and no association remained in the 1990s although it disappeared earlier among younger women. In an analysis by birth cohort, the same pattern was found among women born before 1925, whereas no association between education and mortality was observed among women born after 1925. Educational disparities in breast cancer mortality are currently changing and the previously observed positive gradient has disappeared. An important question is whether these relations are indirect, and due to changes in the prevalence of risk factors associated with education, but which we could not study. (2006) Unlike most causes of death, breast cancer mortality risks have often been higher among women of high socioeconomic status (Faggiano et al, 1997;Heck et al, 1997;Dano et al, 2003Dano et al, , 2004. Some studies, however, found no such association (Lund and Jacobsen, 1991;Faggiano et al, 1997). Most breast cancer risk factors (reproductive behaviour, diet or physical activity) (Dos Santos Silva and Beral, 1997;Potter, 1997) as well as factors related to cancer survival (screening, treatment) (Auvinen and Karjalainen, 1997;Segnan, 1997) are associated with socioeconomic status and their distribution may have changed over time, producing in turn changes in social inequalities in breast cancer mortality. However, the few studies investigating time trends in social inequalities in breast cancer mortality have shown a decrease in socioeconomic disparities (Wagener and Schatzkin, 1994;Martikainen and Valkonen, 2000). British Journal of CancerWe have investigated the time trends in social inequalities in breast cancer mortality among women in France during the period 1968 -1996, with analyses by age at death and birth cohort. MATERIALS AND METHODSIn 1968, the French National Statistics Institute (INSEE) created a longitudinal population study (the 'permanent demographic sample' or EDP), which represented roughly 1% of the French population. The sample includes all persons born on one of four specific calendar dates every year, and is regularly updated to include new subjects with these birthdays (births and immigration). Data are updated at each successive census (1968, 1975, 1982 and 1990). The French National Statistics Institute supervises the keeping of vital records; so the vital status of EDP subjects is systematically monitored (Rouault, 1994). Causes of death were obtaine...

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Socioeconomic status and breast cancer in Denmark

Abstract: During the last quarter of the 20th century academics had the highest risk of breast cancer in Denmark. The size of the social gradient in breast cancer occurrence depended on the measure used. The time trends in social distribution will result in breast cancer becoming more frequent.

Cited by 70 publications

References 20 publications

The relation between socioeconomic and demographic factors and tumour stage in women diagnosed with breast cancer in Denmark, 1983–1999

The relation between socioeconomic and demographic factors and tumour stage in women diagnosed with breast cancer in Denmark, 1983–1999

Cancer risk among patients with multiple sclerosis: A population‐based register study

Social inequalities in breast cancer mortality among French women: disappearing educational disparities from 1968 to 1996

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