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. 2000 Apr;54(4):279–285. doi: 10.1136/jech.54.4.279

Intra-urban differences in breast cancer mortality: a study from the city of Malmö in Sweden

J Manjer 1, G Berglund 1, L Bondesson 1, J P Garne 1, L Janzon 1, A Lindgren 1, J Malina 1, S Matson 1
PMCID: PMC1731663  PMID: 10827910

Abstract

STUDY OBJECTIVE—To assess whether in an urban population stage at breast cancer diagnosis is related to area of living and to what extent intra-urban differences in breast cancer mortality are related to incidence respectively stage at diagnosis.
DESIGN—National registries were used to identify cases. Mortality in 17 residential areas was studied in relation to incidence and stage distribution using linear regression analysis. Areas with high and low breast cancer mortality, incidence and proportion of stage II+ tumours at diagnosis were also compared in terms of their sociodemographic profile.
SETTING—City of Malmö in southern Sweden.
PATIENTS—The 1675 incident breast cancer cases and 448 deaths that occurred in women above 45 years of age in Malmö 1986-96.
MAIN RESULTS—Average annual age standardised breast cancer mortality ranged between residential areas, from 35/105 to 107/105, p=0.04. Mortality of breast cancer was not correlated to incidence, r= 0.22, p=0.39. The ratio of stage II+/0-I cancer incidence varied between areas from 0.45 to 1.99 and was significantly correlated to breast cancer mortality, r= 0.53, p=0.03. Areas with high proportion of stage II+ cancers and high mortality/incidence ratio were characterised by a high proportion of residentials receiving income support, being foreigners and current smokers.
CONCLUSIONS—Within this urban population there were marked differences in breast cancer mortality between residential areas. Stage at diagnosis, but not incidence, contributed to the pattern of mortality. Areas with high proportion of stage II+ tumours differed unfavourably in several sociodemographic aspects from the city average.


Keywords: breast cancer mortality; tumour stage; sociodemographic factors

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Selected References

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  1. Afzelius P., Zedeler K., Sommer H., Mouridsen H. T., Blichert-Toft M. Patient's and doctor's delay in primary breast cancer. Prognostic implications. Acta Oncol. 1994;33(4):345–351. doi: 10.3109/02841869409098427. [DOI] [PubMed] [Google Scholar]
  2. Andersson I., Aspegren K., Janzon L., Landberg T., Lindholm K., Linell F., Ljungberg O., Ranstam J., Sigfússon B. Mammographic screening and mortality from breast cancer: the Malmö mammographic screening trial. BMJ. 1988 Oct 15;297(6654):943–948. doi: 10.1136/bmj.297.6654.943. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Farley T. A., Flannery J. T. Late-stage diagnosis of breast cancer in women of lower socioeconomic status: public health implications. Am J Public Health. 1989 Nov;79(11):1508–1512. doi: 10.2105/ajph.79.11.1508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Goodwin J. S., Freeman J. L., Freeman D., Nattinger A. B. Geographic variations in breast cancer mortality: do higher rates imply elevated incidence or poorer survival? Am J Public Health. 1998 Mar;88(3):458–460. doi: 10.2105/ajph.88.3.458. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Huguley C. M., Jr, Brown R. L., Greenberg R. S., Clark W. S. Breast self-examination and survival from breast cancer. Cancer. 1988 Oct 1;62(7):1389–1396. doi: 10.1002/1097-0142(19881001)62:7<1389::aid-cncr2820620725>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  6. Hurley S. F., Huggins R. M., Jolley D. J., Reading D. Recruitment activities and sociodemographic factors that predict attendance at a mammographic screening program. Am J Public Health. 1994 Oct;84(10):1655–1658. doi: 10.2105/ajph.84.10.1655. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Mackenbach J. P. Socio-economic health differences in The Netherlands: a review of recent empirical findings. Soc Sci Med. 1992 Feb;34(3):213–226. doi: 10.1016/0277-9536(92)90264-q. [DOI] [PubMed] [Google Scholar]
  8. Maunsell E., Brisson J., Deschênes L. Social support and survival among women with breast cancer. Cancer. 1995 Aug 15;76(4):631–637. doi: 10.1002/1097-0142(19950815)76:4<631::aid-cncr2820760414>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  9. Rosén M., Hanning M., Wall S. Changing smoking habits in Sweden: towards better health, but not for all. Int J Epidemiol. 1990 Jun;19(2):316–322. doi: 10.1093/ije/19.2.316. [DOI] [PubMed] [Google Scholar]
  10. Schrijvers C. T., Mackenbach J. P., Lutz J. M., Quinn M. J., Coleman M. P. Deprivation and survival from breast cancer. Br J Cancer. 1995 Sep;72(3):738–743. doi: 10.1038/bjc.1995.403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Smith A. M., Owen N. Associations of social status and health-related beliefs with dietary fat and fiber densities. Prev Med. 1992 Nov;21(6):735–745. doi: 10.1016/0091-7435(92)90080-2. [DOI] [PubMed] [Google Scholar]
  12. Stunkard A. J., Sørensen T. I. Obesity and socioeconomic status--a complex relation. N Engl J Med. 1993 Sep 30;329(14):1036–1037. doi: 10.1056/NEJM199309303291411. [DOI] [PubMed] [Google Scholar]
  13. Sturgeon S. R., Schairer C., Gail M., McAdams M., Brinton L. A., Hoover R. N. Geographic variation in mortality from breast cancer among white women in the United States. J Natl Cancer Inst. 1995 Dec 20;87(24):1846–1853. doi: 10.1093/jnci/87.24.1846. [DOI] [PubMed] [Google Scholar]
  14. Vatten L. J., Foss O. P., Kvinnsland S. Overall survival of breast cancer patients in relation to preclinically determined total serum cholesterol, body mass index, height and cigarette smoking: a population-based study. Eur J Cancer. 1991;27(5):641–646. doi: 10.1016/0277-5379(91)90234-5. [DOI] [PubMed] [Google Scholar]
  15. Wells B. L., Horm J. W. Targeting the underserved for breast and cervical cancer screening: the utility of ecological analysis using the National Health Interview Survey. Am J Public Health. 1998 Oct;88(10):1484–1489. doi: 10.2105/ajph.88.10.1484. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Yu G. P., Ostroff J. S., Zhang Z. F., Tang J., Schantz S. P. Smoking history and cancer patient survival: a hospital cancer registry study. Cancer Detect Prev. 1997;21(6):497–509. [PubMed] [Google Scholar]
  17. Zhang S., Folsom A. R., Sellers T. A., Kushi L. H., Potter J. D. Better breast cancer survival for postmenopausal women who are less overweight and eat less fat. The Iowa Women's Health Study. Cancer. 1995 Jul 15;76(2):275–283. doi: 10.1002/1097-0142(19950715)76:2<275::aid-cncr2820760218>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]

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