Breast cancer stage at diagnosis and area-based socioeconomic status: a multicenter 10-year retrospective clinical epidemiological study in China

Qiong Wang,Zhong-Hua Tang,Rong Huang,Shan Zheng,Jia-Yuan Li,Jin-Hu Fan,Yi Pang,You-Lin Qiao,Jing Li,Hui Li,Bao-Ning Zhang,Jian-Jun He,Xiao-Ming Xie,Hong-Jian Yang,Bin Zhang

doi:10.1186/1471-2407-12-122

Abstract

BackgroundAlthough socioeconomic status (SES) has been focused on as a key determinant of cancer stage at diagosis in western countries, there has been no systemic study on the relationship of SES and breast cancer stage at diagnosis in China.MethodsThe medical charts of 4,211 eligible breast cancer patients from 7 areas across China who were diagnosed between 1999 and 2008 were reviewed. Four area-based socioeconomic indicators were used to calculate area-based SES by cluster analysis. The associations between area-based SES and stage at diagnosis were analyzed by trend chi-square tests. Binary logistic regression was performed to estimate odds ratios for individual demographic characteristics' effects on cancer stages, stratified by area-based SES.ResultsThe individual demographic and pathologic characteristics of breast cancer cases were significantly different among the seven areas studied. More breast cancer cases in low SES areas (25.5%) were diagnosed later (stages III & IV) than those in high (20.4%) or highest (14.8%) SES areas (χ2 for trend = 80.79, P < 0.001). When area-based SES is controlled for, in high SES areas, cases with less education were more likely to be diagnosed at later stages compared with more educated cases. In low SES areas, working women appeared to be diagnosed at earlier breast cancer stages than were homemakers (OR: 0.18-0.26).ConclusionsIn China, women in low SES areas are more likely to be diagnosed at later breast cancer stages than those in high SES areas.

Highlights

Socioeconomic status (SES) has been focused on as a key determinant of cancer stage at diagosis in western countries, there has been no systemic study on the relationship of socioeconomic status (SES) and breast cancer stage at diagnosis in China
In this study, based on the Nationwide Multicenter 10-year (1999-2008) Retrospective Clinical Epidemiological Study of Breast Cancer in China, directed by the Cancer Hospital/Institute, Chinese Academy of Medical Sciences (CICAMS), we explored the effects of both area level factors, namely SES, and individual demographic characteristics on breast cancer stage at diagnosis
Among the other four areas, we found that women in central China had higher education levels, with 27.5% receiving higher education

Summary

Introduction

Socioeconomic status (SES) has been focused on as a key determinant of cancer stage at diagosis in western countries, there has been no systemic study on the relationship of SES and breast cancer stage at diagnosis in China. Breast cancer is by far the most common cancer among women both in developed and developing regions, with an estimated 1.38 million new cancer cases diagnosed worldwide in 2008 (23% of all cancers) [1]. In recent years, both incidence of and mortality from breast. The majority of studies investigating associations between SES and breast cancer stage at diagnosis have documented socioeconomic and geographic disparities, with higher incidence of late stage breast cancer in lower income areas [18,19,20,21,22,23,24]. Regional disparities in SES are significant in China, where economic development in eastern cities generally started earlier and has been faster than that in the country’s interior and in rural areas [25]

Methods

Results

Conclusion