Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
Cambridge University's MRC Biostatistics Unit, Cambridge, UK.
Breast Cancer Res Treat. 2022 Jul;194(2):463-473. doi: 10.1007/s10549-022-06632-1. Epub 2022 Jun 1.
Women from socio-economically deprived areas are less likely to develop and then to survive breast cancer (BC). Whether associations between deprivation and BC incidence and survival differ by tumour molecular subtypes and mode of detection in Scotland are unknown.
Data consisted of 62,378 women diagnosed with invasive BC between 2000 and 2016 in Scotland. Incidence rates and time trends were calculated for oestrogen receptor positive (ER+) and negative (ER-) tumours and stratified by the Scottish Index of Multiple Deprivation (SIMD) quintiles and screening status. SIMD is an area-based measure derived across seven domains: income, employment, education, health, access to services, crime and housing. We calculated adjusted hazard ratios (aHR [95% confidence intervals]) for BC death by immunohistochemical surrogates of molecular subtypes for the most versus the least deprived quintile. We adjusted for mode of detection and other confounders.
In Scotland, screen-detected ER+tumour incidence increased over time, particularly in the least deprived quintile [Average Annual Percentage Change (AAPC) = 2.9% with 95% CI from 1.2 to 4.7]. No marked differences were observed for non-screen-detected ER+tumours or ER- tumours by deprivation. BC mortality was higher in the most compared to the least deprived quintile irrespective of ER status (aHR = 1.29 [1.18, 1.41] for ER+ and 1.27 [1.09, 1.47] for ER- tumours). However, deprivation was associated with significantly higher mortality for luminal A and HER2-enriched tumours (aHR = 1.46 [1.13, 1.88] and 2.10 [1.23, 3.59] respectively) but weaker associations for luminal B and TNBC tumours that were not statistically significant.
Deprivation is associated with differential BC incidence trends for screen-detected ER+tumours and with higher mortality for select tumour subtypes. Future efforts should evaluate factors that might be associated with reduced survival in deprived populations and monitor progress stratified by tumour subtypes and mode of detection.
来自社会经济贫困地区的女性罹患乳腺癌（BC）的可能性较低，且生存机会也较低。在苏格兰，尚不清楚贫困程度与乳腺癌发病率和生存率之间的关系是否因肿瘤分子亚型和检测方式的不同而有所差异。
本研究的数据来源于 2000 年至 2016 年间在苏格兰被诊断为浸润性乳腺癌的 62378 名女性。根据苏格兰多重剥夺指数（SIMD）五分位数和筛查状态，计算了雌激素受体阳性（ER+）和阴性（ER-）肿瘤的发病率和时间趋势。SIMD 是一种基于区域的衡量标准，涉及七个领域：收入、就业、教育、健康、服务获取、犯罪和住房。我们使用分子亚型的免疫组织化学替代物计算了最贫困五分位数与最不贫困五分位数之间的 BC 死亡的调整后的危险比（aHR [95%置信区间]）。我们调整了检测方式和其他混杂因素。
在苏格兰，筛查检出的 ER+肿瘤发病率随时间呈上升趋势，尤其是在最不贫困的五分位数中[平均年变化百分比（AAPC）=2.9%，95%置信区间为 1.2%至 4.7%]。按贫困程度划分，非筛查检出的 ER+肿瘤或 ER-肿瘤并无明显差异。无论 ER 状态如何，BC 死亡率在最贫困五分位数中均高于最不贫困五分位数（ER+肿瘤的 aHR=1.29 [1.18, 1.41]，ER-肿瘤的 aHR=1.27 [1.09, 1.47]）。然而，与最不贫困五分位数相比，luminal A 和 HER2 富集肿瘤的死亡率更高（aHR=1.46 [1.13, 1.88]和 2.10 [1.23, 3.59]），而 luminal B 和三阴性乳腺癌的相关性较弱且无统计学意义。
贫困与筛查检出的 ER+肿瘤的发病率趋势有关，与特定肿瘤亚型的死亡率较高有关。未来的研究应评估可能与贫困人群生存机会降低相关的因素，并按肿瘤亚型和检测方式分层监测进展。
