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Background

Prognostic factors for breast cancer survival in affluent and deprived areas Jasmina Stefoski-Mikeljevic. Background. Survival from breast cancer is improving due to earlier diagnosis and better treatments Survival breast cancer linked to socio-economic status (SES)

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Background

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  1. Prognostic factors for breast cancer survival in affluent and deprived areas Jasmina Stefoski-Mikeljevic

  2. Background • Survival from breast cancer is improving due to earlier diagnosis and better treatments • Survival breast cancer linked to socio-economic status (SES) • SES differences in survival consistent throughout 1980s and 1990s • Multi-factorial reasons tumour biology (ER) other tumour characteristics comorbidity adjuvant treatments type of surgery

  3. SES related survival (Yorkshire) 10-year survival for 1990-1993 (8% difference at 5 years) 5-year survival for 1994-1997 (11% difference)

  4. Study Aim • Identify prognostic factors that may be determinants of SES difference in breast cancer survival in Northern and Yorkshire • Factors examined: age, stage*, type of adjuvant treatment received (CT, RT, Hormone), type of surgery, GP and hospital delay Methods • Retrospective population-based study • Female breast cancer patients diagnosed between 1998-2000 in the area covered by the Northern and Yorkshire Cancer Registry (n=12,880) • Townsend deprivation index *9% of cases with unknown stage

  5. Age at diagnosis by SES p< 0.00001

  6. Stage at diagnosis by SES Likelihood of stage IUnadjusted Age adjusted Affluent 1 1 1 2 0.95 (0.85-1.05) 0.95 (0.84-1.07) 3 0.82 (0.74-0.91) 0.89 (0.79-1.00) Deprived 4 0.79 (0.71-0.87) 0.84 (0.75-0.95)

  7. BCS by SES p< 0.00001

  8. RT by SES p< 0.00001

  9. Mastectomy* 1 1 1 2 1.00 0.90-1.10 0.97 0.87-1.08 3 1.08 0.98-1.20 1.09 0.97-1.21 4 1.14 1.03-1.26 1.16 1.04-1.29 BCS and RT* 1 1 1 2 0.84 0.66-1.06 0.83 0.64-1.06 3 0.75 0.59-0.95 0.73 0.57-0.94 4 0.68 0.62-0.76 0.80 0.62-1.04 1 1 1 Multiple regression analyses (1)Surgery OR 95% CI OR 95% CI Unadjust. Adjusted aff dep aff dep Any Surgery* aff 2 0.89 0.77-1.02 0.82 0.66-1.02 3 0.62 0.54-0.71 0.74 0.60-0.91 dep 4 0.54 0.47-0.61 0.62 0.50-0.76 * Adjusted for age, stage, GP and hospital delay

  10. Hormone therapy 1 1 1 2 1.00 0.88-1.13 1.03 0.89-1.18 3 1.12 0.99-1.27 1.11 0.96-1.28 4 1.11 0.98-1.26 1.10 0.95-1.26 CT 1 1 1 2 0.97 0.87-1.08 1.00 0.86-1.16 3 0.95 0.85-1.06 1.07 0.92-1.25 4 0.87 0.78-0.97 0.97 0.83-1.13 1 1 1 Multiple regression analyses (2)Adjuvant therapy OR 95% CI OR 95% CI Unadjust. Adjusted* aff dep aff dep aff RT 2 0.91 0.82-1.00 0.94 0.82-1.06 3 0.74 0.67-0.81 0.86 0.75-0.98 dep 4 0.69 0.62-0.76 0.82 0.72-0.93 *Adjusted for age, stage, other adjuvant therapies, type of surgery, GP and hospital delay

  11. GP delay (Referral to 1st hosp appoint. >14 days) 1 1 1 2 1.12 0.99-1.26 1.12 0.98-1.26 3 1.05 0.93-1.19 1.06 0.93-1.20 4 1.19 1.05-1.34 1.20 1.07-1.36 Hospital delay (Diagn to 1st treatment >14 days) 1 1 1 2 1.09 0.99-1.21 1.09 0.98-1.20 3 1.08 0.98-1.20 1.12 1.01-1.24 4 1.12 1.00-1.24 1.16 1.05-1.29 Multiple regression analyses (3)GP and hospital delay(>14 days) OR 95% CI OR 95% CI Unadjust. Adjusted* aff dep aff dep * Adjusted for age, stage

  12. Conclusions • Differences between affluent and poor breast cancer patients in -age -stage -type of surgery and RT rates -waiting times for hospital appointment and start of treatment • In addition to already identified factors, poorer survival of breast cancer patients from deprived areas is also likely to be explained by a combination of the the above factors ie. older age, more advanced stage, less surgical treatment, less RT, and longer waits for hospital appointment and start of first treatment

  13. Acknowledgements K Prakash University of Leeds C Craigs NYCRIS D Forman NYCRIS & Uni of Leeds R Haward NYCRIS & Uni of Leeds

  14. The Study Population • 1, 553 patients diagnosed in Yorkshire between 1995 and 2000 • 50cases excluded (treated outside the region and rare types ) Total number of cases: 1,503

  15. Study Population by Age and Stage Age No. % <40 512 34.1 40-59 520 34.6 60-74 259 17.2 75+ 212 14.1 • Median age 46 years • 25.4% 64+ years old (~40% of all deaths) Stage No. % I 852 56.7 II 302 20.1 III 190 12.6 IV 77 5.1 Unknown 82 5.5

  16. Conclusions • Stage at diagnosis is related to patients’ age and socio-economic profile • Treatment pattern of cervical cancer patients during the study period (1995-2000) was in line with what is now considered good management practice recommended in the national guidelines published in 1999 • Survival is influenced by patients’ age and stage, and not by their socio-economic status • Patients managed by higher workload gynaecologists have better survival

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