Breast Cancer ‘Hits Poor Hardest’

Women from deprived backgrounds are treated differently and have a lower breast cancer survival rate than more affluent women, a study suggests. The charity Cancer Research UK studied nearly 13,000 patients from England’s Northern and Yorkshire health regions.

It found deprived women were less likely to be diagnosed in the early stages of disease, when treatment is most likely to be effective. They were also less likely to have surgery or radiotherapy, it said.

The British Journal of Cancer study found that among the most affluent group, 40% had lumpectomies, which allow breast conservation, rather than full mastectomies to remove the breast. However, the figure among the most deprived group was just 31%. The researchers said this was unlikely to be related to the fact that poorer women present later.

They said that more women from deprived areas were likely to favour a mastectomy because it is a one-off treatment, whereas lumpectomy requires a course of radiotherapy, and therefore regular trips to a clinic, which can be difficult and costly.

The study also found that more than 22% of women from deprived backgrounds did not receive surgery, compared with just over 13% of more affluent women. Part of the reason for this disparity was due to late presentation, but the researchers also found women from deprived backgrounds were also more likely to have other health problems which made them unfit for surgery, or to turn down the option.

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.

Lead researcher Professor David Forman, from 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.”

Professor Forman said polices to encourage earlier diagnosis could have some effect in closing inequalities. But he said other complex factors, such as patient choice, probably also played a significant role.

Dr Lesley Walker, Cancer Research UK’s director of information, said women of all backgrounds should take up invitations to have their breasts screened for abnormalities.

Dr Rosemary Gillespie, of the charity Breast Cancer Care, said: “The persistence of inequalities in treatment and outcomes highlights that key messages about breast health and screening are still not reaching those in deprived communities who need them.”

Around 42,000 women are diagnosed each year with breast cancer. Recent statistics predict that almost two thirds of all women newly diagnosed with breast cancer are now likely to survive for at least 20 years.