Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2001 May;55(5):308–315. doi: 10.1136/jech.55.5.308

Prognostic factors in women with breast cancer: distribution by socioeconomic status and effect on differences in survival

C Thomson 1, D Hole 1, C Twelves 1, D Brewster 1, R Black 1
PMCID: PMC1731899  PMID: 11297648

Abstract

STUDY OBJECTIVE—To quantify and investigate differences in survival from breast cancer between women resident in affluent and deprived areas and define the contribution of underlying factors to this variation.
DESIGN—Analysis of two datasets relating to breast cancer patients in Scotland: (1) population-based cancer registry data; (2) a subset of cancer registration records supplemented by abstraction of prognostic variables (stage, node status, tumour size, oestrogen receptor (ER) status, type of surgery, use of radiotherapy and use of adjuvant systemic therapy) from medical records.
SETTING—Scotland.
PATIENTS—(1) Cancer registration data on 21 751 women aged under 85 years diagnosed with primary breast cancer between 1978 and 1987; (2) national clinical audit data on 2035 women aged under 85 years diagnosed with primary breast cancer during 1987 for whom adequate medical records were available.
MAIN RESULTS—Survival differences of 10% between affluent and deprived women were observed in both datasets, across all age groups. In the audit dataset, the distribution of ER status varied by deprivation group (65% ER positive in affluent group v 48% ER positive in deprived group; under 65 age group). Women aged under 65 with non-metastatic disease were more likely to have breast conservation than a mastectomy if they were affluent (45%) than deprived (32%); the affluent were more likely to receive endocrine therapy (65%) than the deprived (50%). However, these factors accounted for about 20% of the observed difference in survival between women resident in affluent and deprived areas.
CONCLUSIONS—Deprived women with breast cancer have poorer outcomes than affluent women. This can only partly be explained by deprived women having more ER negative tumours than affluent women. Further research is required to identify other reasons for poorer outcomes in deprived women, with a view to reducing these survival differences.


Keywords: socioeconomic status; survival; oestrogen receptor status

Full Text

The Full Text of this article is available as a PDF (162.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berg J. W., Ross R., Latourette H. B. Economic status and survival of cancer patients. Cancer. 1977 Feb;39(2):467–477. doi: 10.1002/1097-0142(197702)39:2<467::aid-cncr2820390215>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  2. Brewster D. H., Crichton J., Harvey J. C., Dawson G. Completeness of case ascertainment in a Scottish regional cancer registry for the year 1992. Public Health. 1997 Sep;111(5):339–343. doi: 10.1016/s0033-3506(97)00065-6. [DOI] [PubMed] [Google Scholar]
  3. Brewster D., Crichton J., Muir C. How accurate are Scottish cancer registration data? Br J Cancer. 1994 Nov;70(5):954–959. doi: 10.1038/bjc.1994.428. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Carnon A. G., Ssemwogerere A., Lamont D. W., Hole D. J., Mallon E. A., George W. D., Gillis G. R. Relation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer. BMJ. 1994 Oct 22;309(6961):1054–1057. doi: 10.1136/bmj.309.6961.1054. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chevallier B., Heintzmann F., Mosseri V., Dauce J. P., Bastit P., Graic Y., Brunelle P., Basuyau J. P., Comoz M., Asselain B. Prognostic value of estrogen and progesterone receptors in operable breast cancer. Results of a univariate and multivariate analysis. Cancer. 1988 Dec 15;62(12):2517–2524. doi: 10.1002/1097-0142(19881215)62:12<2517::aid-cncr2820621211>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  6. Crowe J. P., Jr, Gordon N. H., Hubay C. A., Shenk R. R., Zollinger R. M., Brumberg D. J., McGuire W. L., Shuck J. M. Estrogen receptor determination and long term survival of patients with carcinoma of the breast. Surg Gynecol Obstet. 1991 Oct;173(4):273–278. [PubMed] [Google Scholar]
  7. Gordon N. H. Association of education and income with estrogen receptor status in primary breast cancer. Am J Epidemiol. 1995 Oct 15;142(8):796–803. doi: 10.1093/oxfordjournals.aje.a117718. [DOI] [PubMed] [Google Scholar]
  8. Gordon N. H., Crowe J. P., Brumberg D. J., Berger N. A. Socioeconomic factors and race in breast cancer recurrence and survival. Am J Epidemiol. 1992 Mar 15;135(6):609–618. doi: 10.1093/oxfordjournals.aje.a116340. [DOI] [PubMed] [Google Scholar]
  9. Karjalainen S., Pukkala E. Social class as a prognostic factor in breast cancer survival. Cancer. 1990 Aug 15;66(4):819–826. doi: 10.1002/1097-0142(19900815)66:4<819::aid-cncr2820660437>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  10. Kendrick S., Clarke J. The Scottish Record Linkage System. Health Bull (Edinb) 1993 Mar;51(2):72–79. [PubMed] [Google Scholar]
  11. Kogevinas M., Porta M. Socioeconomic differences in cancer survival: a review of the evidence. IARC Sci Publ. 1997;(138):177–206. [PubMed] [Google Scholar]
  12. Macleod U., Ross S., Gillis C., McConnachie A., Twelves C., Watt G. C. Socio-economic deprivation and stage of disease at presentation in women with breast cancer. Ann Oncol. 2000 Jan;11(1):105–107. doi: 10.1023/a:1008385321476. [DOI] [PubMed] [Google Scholar]
  13. Macleod U., Ross S., Twelves C., George W. D., Gillis C., Watt G. C. Primary and secondary care management of women with early breast cancer from affluent and deprived areas: retrospective review of hospital and general practice records. BMJ. 2000 May 27;320(7247):1442–1445. doi: 10.1136/bmj.320.7247.1442. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Maudsley G., Williams E. M. Death certification by house officers and general practitioners--practice and performance. J Public Health Med. 1993 Jun;15(2):192–201. [PubMed] [Google Scholar]
  15. Newman S. C., Lees A. W., Jenkins H. J. The effect of body mass index and oestrogen receptor level on survival of breast cancer patients. Int J Epidemiol. 1997 Jun;26(3):484–490. doi: 10.1093/ije/26.3.484. [DOI] [PubMed] [Google Scholar]
  16. Pollock A. M., Vickers N. Breast, lung and colorectal cancer incidence and survival in South Thames Region, 1987-1992: the effect of social deprivation. J Public Health Med. 1997 Sep;19(3):288–294. doi: 10.1093/oxfordjournals.pubmed.a024632. [DOI] [PubMed] [Google Scholar]
  17. Sainsbury R., Haward B., Rider L., Johnston C., Round C. Influence of clinician workload and patterns of treatment on survival from breast cancer. Lancet. 1995 May 20;345(8960):1265–1270. doi: 10.1016/s0140-6736(95)90924-9. [DOI] [PubMed] [Google Scholar]
  18. Schrijvers C. T., Coebergh J. W., van der Heijden L. H., Mackenbach J. P. Socioeconomic variation in cancer survival in the southeastern Netherlands, 1980-1989. Cancer. 1995 Jun 15;75(12):2946–2953. doi: 10.1002/1097-0142(19950615)75:12<2946::aid-cncr2820751223>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  19. 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]
  20. Shek L. L., Godolphin W. Model for breast cancer survival: relative prognostic roles of axillary nodal status, TNM stage, estrogen receptor concentration, and tumor necrosis. Cancer Res. 1988 Oct 1;48(19):5565–5569. [PubMed] [Google Scholar]
  21. Twelves C. J., Thomson C. S., Gould A., Dewar J. A. Variation in the survival of women with breast cancer in Scotland. The Scottish Breast Cancer Focus Group and The Scottish Cancer Therapy Network. Br J Cancer. 1998 Sep;78(5):566–571. doi: 10.1038/bjc.1998.541. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES