Abstract
We evaluated the relationship between breast cancer survival and deprivation using data from the Irish National Cancer Registry. Cause-specific survival was compared between five area-based socioeconomic deprivation strata using Cox regression. Patient and tumour characteristics and treatment were compared using modified Poisson regression with robust variance estimation. Based on 21356 patients diagnosed 1999–2008, age-standardized five-year survival averaged 80% in the least deprived and 75% in the most deprived stratum. Age-adjusted mortality risk was 33% higher in the most deprived group (hazard ratio 1.33, 95% CI 1.21–1.45, P<0.001). The most deprived groups were more likely to present with advanced stage, high grade or hormone receptor-negative cancer, symptomatically, or with significant comorbidity, and to be smokers or unmarried, and less likely to have breast-conserving surgery. Cox modelling suggested that the available data on patient, tumour and treatment factors could account for only about half of the survival disparity (adjusted hazard ratio 1.18, 95% CI 0.97–1.43, P = 0.093). Survival disparity did not diminish over time, compared with the period 1994–1998. Persistent survival disparities among Irish breast cancer patients suggest unequal use of or access to services and highlight the need for further research to understand and remove the behavioural or other barriers involved.
Highlights
The incidence of invasive breast cancer in Irish women has increased steadily since national statistics were first collated in 1994
We evaluated socioeconomic influences on breast cancer survival in Ireland using data collected by the National Cancer Registry
Patient and tumour characteristics and treatments were compared between deprivation strata using modified Poisson regression with robust variance estimation, generating relative risks (RRs), more appropriate than odds ratios for such analyses [39]
Summary
The incidence of invasive breast cancer in Irish women has increased steadily since national statistics were first collated in 1994. Factors that can adversely affect survival rates after breast cancer, including their relationship to socioeconomic deprivation, have been extensively studied elsewhere They include, among others, comorbidity [2,3,4,5], region of residence [6], educational attainment [7,8,9,10], participation in screening programmes [4,11,12], and diagnosis at a late stage [13,14,15,16,17,18,19]. On the whole there has been relatively little consensus as to the mechanisms or the importance of contributory or mediating factors involved, stage at diagnosis and access to adequate treatment are widely seen as the most important
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