Borghi Giulio, Delacôte Claire, Delacour-Billon Solenne, Ayrault-Piault Stéphanie, Dabakuyo-Yonli Tienhan Sandrine, Delafosse Patricia, Woronoff Anne-Sophie, Trétarre Brigitte, Molinié Florence, Cowppli-Bony Anne
Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France.
SIRIC ILIAD INCa-DGOS-INSERM-ITMO Cancer_18011, CHU Nantes, 44000 Nantes, France.
Cancers (Basel). 2024 Apr 27;16(9):1701. doi: 10.3390/cancers16091701.
In this study, we assessed the influence of area-based socioeconomic deprivation on the incidence of invasive breast cancer (BC) in France, according to stage at diagnosis. All women from six mainland French departments, aged 15+ years, and diagnosed with a primary invasive breast carcinoma between 2008 and 2015 were included ( = 33,298). Area-based socioeconomic deprivation was determined using the French version of the European Deprivation Index. Age-standardized incidence rates (ASIR) by socioeconomic deprivation and stage at diagnosis were compared estimating incidence rate ratios (IRRs) adjusted for age at diagnosis and rurality of residence. Compared to the most affluent areas, significantly lower IRRs were found in the most deprived areas for all-stages (0.85, 95% CI 0.81-0.89), stage I (0.77, 95% CI 0.72-0.82), and stage II (0.84, 95% CI 0.78-0.90). On the contrary, for stages III-IV, significantly higher IRRs (1.18, 95% CI 1.08-1.29) were found in the most deprived areas. These findings provide a possible explanation to similar or higher mortality rates, despite overall lower incidence rates, observed in women living in more deprived areas when compared to their affluent counterparts. Socioeconomic inequalities in access to healthcare services, including screening, could be plausible explanations for this phenomenon, underlying the need for further research.
在本研究中，我们根据诊断时的分期，评估了法国地区层面的社会经济剥夺对浸润性乳腺癌（BC）发病率的影响。纳入了来自法国本土六个省份、年龄在15岁及以上、于2008年至2015年间被诊断为原发性浸润性乳腺癌的所有女性（n = 33298）。使用欧洲剥夺指数的法语版本确定地区层面的社会经济剥夺情况。比较了按社会经济剥夺程度和诊断时分期划分的年龄标准化发病率（ASIR），估算了经诊断年龄和居住农村情况调整后的发病率比（IRR）。与最富裕地区相比，在所有分期（0.85，95%CI 0.81 - 0.89）、I期（0.77，95%CI 0.72 - 0.82）和II期（0.84，95%CI 0.78 - 0.90）的最贫困地区，IRR显著更低。相反，对于III - IV期，在最贫困地区发现IRR显著更高（1.18，95%CI 1.08 - 1.29）。这些发现为以下现象提供了一种可能的解释：与富裕地区的女性相比，生活在更贫困地区的女性尽管总体发病率较低，但死亡率却相似或更高。获得包括筛查在内的医疗服务方面的社会经济不平等可能是这一现象的合理原因，这凸显了进一步研究的必要性。
