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
نویسندگان
چکیده
BACKGROUND Breast cancer survival is higher in less deprived women, even amongst women whose tumor was screen-detected, but reasons behind this have not been comprehensively investigated. METHODS The excess hazard of breast cancer death in 20,265 women diagnosed with breast cancer, followed up to 2012, was estimated for screen-detected and non-screen-detected women, comparing more deprived to less deprived women using flexible parametric models. Models were adjusted for individual and tumor factors, treatment received and comorbidity. For screen-detected women, estimates were also corrected for lead-time and overdiagnosis. RESULTS The excess hazard ratio (EHR) of breast cancer death in the most deprived group, adjusted only for age and year of diagnosis, was twice that of the least deprived among screen-detected women (EHR=2.12, 95%CI 1.48-2.76) and 64% higher among non-screen-detected women (EHR=1.64, 95%CI 1.41-1.87). Adjustment for stage at diagnosis lowered these estimates by 25%. Further adjustment had little extra impact. In the final models, the excess hazard for the most deprived women was 54% higher (EHR=1.54, 95%CI 1.10-1.98) among screen-detected women and 39% higher (EHR=1.39, 95%CI 1.20-1.59) among non-screen-detected women. CONCLUSION A persistent socio-economic gradient in breast cancer-related death exists in this cohort, even for screen-detected women. The impact of differential lifestyles, management and treatment warrant further investigation.
منابع مشابه
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
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 rol...
متن کاملAre international differences in breast cancer survival between Australia and the UK present amongst both screen‐detected women and non‐screen‐detected women? survival estimates for women diagnosed in West Midlands and New South Wales 1997–2006
We examined survival in screened-detected and non-screen-detected women diagnosed in the West Midlands (UK) and New South Wales (Australia) in order to evaluate whether international differences in survival are related to early diagnosis, or to other factors relating to the healthcare women receive. Data for women aged 50 - 65 years who had been eligible for screening from 50 years were examine...
متن کاملWoods, LM; Morris, M; Rachet, B (2016) No ’cure’ within 12 years of diagnosis amongst breast cancer patients who are diagnosed via mammographic screening: women diagnosed in the West Midlands region of England 1989-2011. Annals of oncology
متن کامل
Comparison of Random Survival Forests for Competing Risks and Regression Models in Determining Mortality Risk Factors in Breast Cancer Patients in Mahdieh Center, Hamedan, Iran
Introduction: Breast cancer is one of the most common cancers among women worldwide. Patients with cancer may die due to disease progression or other types of events. These different event types are called competing risks. This study aimed to determine the factors affecting the survival of patients with breast cancer using three different approaches: cause-specific hazards regression, subdistri...
متن کاملSocio-economic inequalities in survival from screen-detected breast cancer in South West England: population-based cohort study.
BACKGROUND Socio-economic inequalities in breast cancer survival have been reported worldwide, but whether these exist in screen detected as well as symptomatic women has not been established. Making this distinction will allow inferences about the relative contributions of pre- and post-diagnostic delay to these inequalities. METHODS Screening-eligible women diagnosed with breast cancer in S...
متن کامل