Norredam M, Groenvold M, Petersen J H, Krasnik A
Department of Health Services Research, Institute of Public Health, University of Copenhagen, Denmark.
Soc Sci Med. 1998 Dec;47(11):1659-63. doi: 10.1016/s0277-9536(98)00260-3.
This study examines the effect of socio-economic inequalities on the tumour size at diagnosis and the choice of surgical treatment in Danish women with breast cancer. The Danish Breast Cancer Cooperative Group (DBCG) registers all women with breast cancer in Denmark and provides clinical register data on tumour size and surgical treatment for 1594 women <75 yr diagnosed with breast cancer between 1991 and 1996. A questionnaire including questions on social class was sent to the women. The tumour size at diagnosis (an indicator of access to treatment) and the surgical procedure (lumpectomy or mastectomy) for patients who were potential candidates for lumpectomy were the main outcome measures examined. Social class was not associated with tumour size at diagnosis. The tumour size was associated with age and the existence of a mammographic screening program in the county. However, treatment was strongly related to social class. Among women considered candidates for lumpectomy 77% underwent lumpectomy in the highest social class, compared to 50% in the lowest social class. Treatment was associated with age, tumour size and hospital status. It was concluded that the study showed no socio-economic inequalities related to access to health services as measured by tumour size, though significant social differences were found regarding treatment.
本研究调查了社会经济不平等对丹麦乳腺癌女性患者诊断时肿瘤大小及手术治疗选择的影响。丹麦乳腺癌协作组（DBCG）登记了丹麦所有乳腺癌女性患者，并提供了1991年至1996年间确诊的1594名75岁以下乳腺癌女性患者的肿瘤大小和手术治疗的临床登记数据。向这些女性发送了一份包含社会阶层问题的问卷。诊断时的肿瘤大小（治疗可及性的一个指标）以及潜在保乳手术候选患者的手术方式（保乳手术或乳房切除术）是所考察的主要结局指标。社会阶层与诊断时的肿瘤大小无关。肿瘤大小与年龄以及所在县是否存在乳房X线筛查项目有关。然而，治疗与社会阶层密切相关。在被认为适合保乳手术的女性中，社会阶层最高的女性中有77%接受了保乳手术，而社会阶层最低的女性中这一比例为50%。治疗与年龄、肿瘤大小和医院状况有关。研究得出结论，尽管在治疗方面发现了显著的社会差异，但以肿瘤大小衡量，该研究未显示出与卫生服务可及性相关的社会经济不平等。
