Oncoplastic Breast Surgery Unit, Nevill Hall Hospital, Abergavenny, UK.
Welsh Cancer Intelligence & Surveillance Unit, Public Health Wales, Cardiff, UK.
Surgeon. 2019 Apr;17(2):88-96. doi: 10.1016/j.surge.2018.05.004. Epub 2018 Jun 20.
Breast cancer, historically a disease of more affluent women, has increased in incidence for women from areas of greater social deprivation, yet prognosis is worse for these women. This study identifies differences in presentation, treatment and prognostic factors between the socioeconomic groups.
Patient data obtained from the prospectively maintained Welsh national Cancer Network Information System Cymru, for an 11-year period, were categorised according to Welsh Index of Multiple Deprivation quintiles. Quintiles were compared for differences in variables relating to patient characteristics, detection of cancer, tumour biology and treatment.
1570 patients were included. Analysis showed that in the more socially deprived quintiles, there are proportionally fewer women being diagnosed through the NHS breast cancer screening programme and as a consequence greater numbers of women from poorer areas being diagnosed outwith the screening age parameters. Screen detection is strongly associated with better prognosis in terms of Nottingham Prognostic Index. Similarly, increasing levels of social deprivation are associated with higher incidence of oestrogen receptor negative and triple negative tumours, both features associated with a shorter disease free and overall survival. Other variables of tumour biology, rates and type of surgical and adjuvant treatment were similar across social deprivation quintiles.
There is a trend of reduced early detection of breast cancer in South East Wales in those patients living in areas of higher social deprivation. Given that there is equity in access to treatment within NHS, which is free for patients at the point of care, further study is warranted to address this existing disparity. Population cancer surveillance will need to inform both public health and NHS service responses, to continue to achieve improvements. Health trends may yet alter depending on current and future shifts in governmental health policy.
乳腺癌曾是一种较为富裕女性的疾病，但在社会资源匮乏地区，乳腺癌的发病率在女性中有所上升，而这些女性的预后更差。本研究旨在确定社会经济群体之间在表现、治疗和预后因素方面的差异。
通过前瞻性维护的威尔士国家癌症网络信息系统 Cymru 获得 11 年的患者数据，并根据威尔士多重剥夺指数五分位数进行分类。对与患者特征、癌症检测、肿瘤生物学和治疗相关的变量进行五分位数比较，以确定差异。
共纳入 1570 例患者。分析表明，在社会资源匮乏程度较高的五分位数中，通过国民保健制度（NHS）乳腺癌筛查计划诊断的女性比例较低，因此，来自贫困地区的更多女性在筛查年龄参数之外被诊断出来。在诺丁汉预后指数方面，筛查检测与更好的预后密切相关。同样，社会经济地位越低，雌激素受体阴性和三阴性肿瘤的发病率越高，这两个特征都与无病生存和总生存时间缩短有关。肿瘤生物学的其他变量、手术和辅助治疗的比率和类型在社会经济地位五分位数中相似。
在东南威尔士地区，社会经济地位较高的患者中，乳腺癌的早期检测呈下降趋势。考虑到在 NHS 中，治疗是免费的，患者在接受治疗时可以公平地获得治疗，因此有必要进一步研究以解决这一现有差距。人群癌症监测需要为公共卫生和 NHS 服务提供信息，以继续取得进展。健康趋势可能会根据当前和未来政府卫生政策的变化而改变。
