Abstract
PurposeThe stage-specific survival of young breast cancer patients has improved, likely due to diagnostic and treatment advances. We addressed whether survival improvements have reached all socioeconomic groups in a country with universal health care and national treatment guidelines.MethodsUsing Norwegian registry data, we assessed stage-specific breast cancer survival by education and income level of 7501 patients (2317 localized, 4457 regional, 233 distant and 494 unknown stage) aged 30–48 years at diagnosis during 2000–2015. Using flexible parametric models and national life tables, we compared excess mortality up to 12 years from diagnosis and 5-year relative survival trends, by education and income as measures of socioeconomic status (SES).ResultsThroughout 2000–2015, regional and distant stage 5-year relative survival improved steadily for patients with high education and high income (high SES), but not for patients with low education and low income (low SES). Regional stage 5-year relative survival improved from 85 to 94% for high SES patients (9% change; 95% confidence interval: 6, 13%), but remained at 84% for low SES patients (0% change; − 12, 12%). Distant stage 5-year relative survival improved from 22 to 58% for high SES patients (36% change; 24, 49%), but remained at 11% for low SES patients (0% change; − 19, 19%).ConclusionsRegional and distant stage breast cancer survival has improved markedly for high SES patients, but there has been little survival gain for low SES patients. Socioeconomic status matters for the stage-specific survival of young breast cancer patients, even with universal health care.
Highlights
Stage-specific and overall survival of breast cancer patients has improved over time [1, 2], probably due to advances in diagnostics and treatment
New treatments have improved the survival of patients with certain tumor subtypes, for example Herceptin has improved the survival of HER2 positive patients [7, 8]
When education and income were examined in combination, we found both socioeconomic factors influenced regional stage relative survival, but education seemed a stronger predictor than income of distant stage relative survival (Fig. 2c)
Summary
Stage-specific and overall survival of breast cancer patients has improved over time [1, 2], probably due to advances in diagnostics and treatment. Breast cancer survival has been improving, there is concern that patients with low socioeconomic status (SES) have not gained as much from recent advancements [9,10,11,12,13,14]. Norway has a universal tax funded health care system with the aim to minimize socioeconomic differences in access to diagnostic and treatment care. Young women fare worse than screen-aged women in terms of breast cancer survival, even after adjustment for tumor characteristics [15,16,17]
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