Thomson C S, Hole D J, Twelves C J, Brewster D H, Black R J
Scottish Cancer Intelligence Unit, Information and Statistics Division, Trinity Park House, Edinburgh EH5 3SQ, UK.
J Epidemiol Community Health. 2001 May;55(5):308-15. doi: 10.1136/jech.55.5.308.
To quantify and investigate differences in survival from breast cancer between women resident in affluent and deprived areas and define the contribution of underlying factors to this variation.
Analysis of two datasets relating to breast cancer patients in Scotland: (1) population-based cancer registry data; (2) a subset of cancer registration records supplemented by abstraction of prognostic variables (stage, node status, tumour size, oestrogen receptor (ER) status, type of surgery, use of radiotherapy and use of adjuvant systemic therapy) from medical records.
Scotland.
(1) Cancer registration data on 21,751 women aged under 85 years diagnosed with primary breast cancer between 1978 and 1987; (2) national clinical audit data on 2035 women aged under 85 years diagnosed with primary breast cancer during 1987 for whom adequate medical records were available.
Survival differences of 10% between affluent and deprived women were observed in both datasets, across all age groups. In the audit dataset, the distribution of ER status varied by deprivation group (65% ER positive in affluent group v 48% ER positive in deprived group; under 65 age group). Women aged under 65 with non-metastatic disease were more likely to have breast conservation than a mastectomy if they were affluent (45%) than deprived (32%); the affluent were more likely to receive endocrine therapy (65%) than the deprived (50%). However, these factors accounted for about 20% of the observed difference in survival between women resident in affluent and deprived areas.
Deprived women with breast cancer have poorer outcomes than affluent women. This can only partly be explained by deprived women having more ER negative tumours than affluent women. Further research is required to identify other reasons for poorer outcomes in deprived women, with a view to reducing these survival differences.
量化并调查居住在富裕地区和贫困地区的女性乳腺癌生存率差异，并确定潜在因素对这种差异的影响。
对两个与苏格兰乳腺癌患者相关的数据集进行分析：（1）基于人群的癌症登记数据；（2）癌症登记记录的一个子集，通过从医疗记录中提取预后变量（分期、淋巴结状态、肿瘤大小、雌激素受体（ER）状态、手术类型、放疗使用情况和辅助全身治疗使用情况）进行补充。
苏格兰。
（1）1978年至1987年间诊断为原发性乳腺癌的21751名85岁以下女性的癌症登记数据；（2）1987年期间诊断为原发性乳腺癌且有完整医疗记录的2035名85岁以下女性的国家临床审计数据。
在两个数据集中，所有年龄组的富裕女性和贫困女性的生存率差异均为10%。在审计数据集中，ER状态的分布因贫困组而异（富裕组中65%为ER阳性，贫困组中48%为ER阳性；65岁以下年龄组）。65岁以下患有非转移性疾病的女性，如果她们富裕（45%），则比贫困（32%）的女性更有可能接受保乳手术；富裕女性比贫困女性更有可能接受内分泌治疗（65%对50%）。然而，这些因素约占富裕地区和贫困地区女性生存率差异的20%。
患有乳腺癌的贫困女性的预后比富裕女性差。这只能部分解释为贫困女性比富裕女性有更多ER阴性肿瘤。需要进一步研究以确定贫困女性预后较差的其他原因，以期减少这些生存率差异。
