National Institute for Health and Care Excellence, London, UK.
Cancer Control. 2024 Jan-Dec;31:10732748241293976. doi: 10.1177/10732748241293976.
Health inequalities refer to systematic, unfair and avoidable differences in health across the population and between different groups in society. We reviewed health inequalities related to breast cancer to inform National Institute for Health and Care Excellence (NICE) recommendations. This was a pragmatic, targeted review to identify examples of health inequalities related to breast cancer in England. The search focused on national cancer registries, screening programme datasets, patient experience surveys and reports from key organisations. The results were synthesised using 5 domains of interest, covering health status, risk factors, wider determinants, access to and quality and experience of care. These domains were subdivided across 4 dimensions of health inequalities, including deprivation, geography, protected characteristics, and inclusion health groups. It was found that although breast cancer is less common in more deprived groups, these groups have worse health outcomes and higher mortality rates compared to less deprived groups. Many disadvantaged groups are less likely to participate in breast cancer screening, leading to delayed diagnosis and more advanced cancers. Behavioural risk factors such as obesity, physical inactivity and alcohol consumption vary across groups and impact breast cancer risks and outcomes. While people from ethnic minority groups have lower breast cancer incidence, evidence suggests that the incidence of breast cancer in some groups is increasing. Ethnic minority groups are also often diagnosed at advanced stages due to presenting through non-screening routes. Low health literacy is an issue for many disadvantaged groups. This review demonstrates that late diagnosis and low screening uptake significantly contribute to health inequalities among different groups, including deprived and ethnic minority groups. There are many gaps in the evidence, and this review further highlights potential research areas for the broader health and care system from the perspective of health inequalities.
健康不平等是指人群中以及社会不同群体之间存在的系统性、不公平和可避免的健康差异。我们审查了与乳腺癌相关的健康不平等现象，为国家卫生与保健卓越研究所（NICE）的建议提供信息。这是一项务实的、有针对性的审查，旨在确定英格兰与乳腺癌相关的健康不平等现象的实例。该搜索重点关注国家癌症登记处、筛查计划数据集、患者体验调查和主要组织的报告。使用 5 个感兴趣的领域对结果进行了综合分析，涵盖健康状况、风险因素、更广泛的决定因素、获得和护理质量及体验。这些领域分为健康不平等的 4 个维度，包括贫困、地理位置、受保护特征和包容健康群体。结果发现，尽管乳腺癌在较贫困群体中较少见，但这些群体的健康状况较差，死亡率较高。许多弱势群体参与乳腺癌筛查的可能性较小，导致诊断延迟和癌症更晚期。行为风险因素，如肥胖、身体活动不足和饮酒，在不同群体中存在差异，并影响乳腺癌的风险和结果。虽然少数族裔群体的乳腺癌发病率较低，但有证据表明，一些群体的乳腺癌发病率正在上升。少数族裔群体也经常因通过非筛查途径就诊而被诊断为晚期。低健康素养是许多弱势群体面临的问题。这项审查表明，不同群体（包括贫困和少数族裔群体）之间的健康不平等主要是由于诊断延迟和筛查参与率低造成的。证据存在许多空白，从健康不平等的角度来看，这一审查进一步突出了更广泛的卫生和保健系统的潜在研究领域。
