Women from poor backgrounds fare worse with breast cancer

Mar 7 2007

Women from more deprived backgrounds have worse treatment and a lower breast cancer survival rate than their more affluent counterparts - according to a new study published by Cancer Research UK in the British Journal of Cancer.

Almost 13,000 patients from the Northern and Yorkshire regions, diagnosed between 1998 and 2000, were studied to assess the differences in diagnosis, treatment and survival of women who came from different social and economic backgrounds.

Researchers found that women who came from the most deprived areas were less likely to be diagnosed when breast cancer was at an early stage than those women from the most affluent backgrounds.

Women from less affluent areas were correspondingly more likely to be diagnosed at the later stages of the disease when treatment is less likely to be as effective.

There was also a difference in treatment - irrespective of late presentation. Among the most affluent, 40 percent had lumpectomies which allow breast conservation rather than full mastectomies; among the most deprived only 31 per cent received lumpectomies.

More than 22 per cent of women from deprived backgrounds did not receive surgery as opposed to just over 13 percent of more affluent women. Reasons for this included women presenting late, having additional health problems making them unfit for surgery or choosing not to have surgery.

A slightly higher proportion of affluent women were seen within 14 days of referral by their doctor than women from more deprived areas. Women in deprived areas were less likely to be given radiotherapy and, on average, had a lower rate of five-year survival.

Professor David Forman, who led the study funded by Cancer Research UK and is based at Leeds University, said: "Part of the problem we have identified may be based on the fact that women from a more deprived background are diagnosed when the disease is more advanced. This means that treatment decisions are more complex.

An additional problem with radiotherapy is that this treatment is often intensive and may involve regular visits to a radiotherapy clinic over several weeks. It can be very expensive when patients need to travel long distances for treatment, and this may have an impact on decisions about treatment in those from deprived areas.

"The gap in survival rates could be reduced by national policies to encourage earlier diagnosis and appropriate treatment for patients. But the divide we have identified between affluent and deprived may also depend on more complex issues affecting patient choice and this needs further investigation."

Dr Lesley Walker, Cancer Research UK's director of information, said: "It is very worrying that differences in diagnosis, treatment and survival exist between women from different backgrounds.

"Women of all backgrounds are invited for breast screening after the age of 50. If everyone takes up these invitations there is a better chance that any signs of breast cancer can be quickly diagnosed and treated. Early diagnosis means women have a better chance of long-term survival."

"Cancer Research UK's Reduce the Risk campaign urges women to get to know their bodies, to notice any changes and to be aware of what is normal for them. Taking up invitations for screening can save lives."