Small but significant socioeconomic inequalities in axillary staging and treatment of breast cancer in the Netherlands

Abstract

Background:The use of sentinel node biopsy (SNB), lymph node dissection, breast-conserving surgery, radiotherapy, chemotherapy and hormonal treatment for breast cancer was evaluated in relation to socioeconomic status (SES) in the Netherlands, where access to care was assumed to be equal.Methods:Female breast cancer patients diagnosed between 1994 and 2008 were selected from the nationwide population-based Netherlands Cancer Registry (N=176 505). Socioeconomic status was assessed based on income, employment and education at postal code level. Multivariable models included age, year of diagnosis and stage.Results:Sentinal node biopsy was less often applied in high-SES patients (multivariable analyses, ⩽49 years: odds ratio (OR) 0.70 (95% CI: 0.56–0.89); 50–75 years: 0.85 (0.73–0.99)). Additionally, lymph node dissection was less common in low-SES patients aged ⩾76 years (OR 1.34 (0.95–1.89)). Socioeconomic status-related differences in treatment were only significant in the age group 50–75 years. High-SES women with stage T1–2 were more likely to undergo breast-conserving surgery (+radiotherapy) (OR 1.15 (1.09–1.22) and OR 1.16 (1.09–1.22), respectively). Chemotherapy use among node-positive patients was higher in the high-SES group, but was not significant in multivariable analysis. Hormonal therapy was not related to SES.Conclusion:Small but significant differences were observed in the use of SNB, lymph node dissection and breast-conserving surgery according to SES in Dutch breast cancer patients despite assumed equal access to health care.