Later diagnosis, less first-course treatment and race are the main reasons for the difference in mortality between rich and poor breast cancer patients. A new study, published in the open access journal BMC Cancer, suggests that targeted interventions to increase breast cancer screening and treatment coverage in worse-off patients could reduce much of the socioeconomic disparity in survival.
Xue Qin Yu, who conducted the analysis while employed with the American Cancer Society, studied the records of more than 112,500 women diagnosed with breast cancer in the United States between 1998 and 2002. These women were followed up until the end of 2005 and, as expected, socio-economic status (SES) was significantly associated with the likelihood of surviving. Yu said, "Women living in the lowest SES areas had the lowest percentage of early stage cancer, and the highest percentage of advanced stages, at the time of diagnosis. The proportion of black women living in the lowest SES areas was nearly four times higher than that of the highest SES areas. Furthermore, women in the lowest SES areas were significantly less likely to receive first course treatment".
Yu suggests that the unfavourable stage distribution for women from the lowest SES areas was likely caused by lower mammography rates. Lack of health insurance and lower financial resources are known to be associated with lower mammography rates and lack of, or delayed, follow-up after an abnormal mammogram. Race may be associated with breast cancer survival independent of other factors, but this study has limited ability to separate out these multiple dimensions. Finally, the observed poorer survival in non-metropolitan areas may be due to factors related to access to and time waiting for chemotherapy and/or radiotherapy after breast cancer surgery.
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