Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care
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Francesca Di Salvo1, Nicola Caranci2, Teresa Spadea3, Nicolas Zengarini3, Pamela Minicozzi1, Hade Amash1, Mario Fusco4, Fabrizio Stracci5, Fabio Falcini6, Claudia Cirilli7, Giuseppina Candela8, Rosanna Cusimano9, Rosario Tumino10 and Milena Sant1 for the Socioeconomic Inequalities and Oncological Outcomes Italian Working Group*
1Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
2Agenzia Sanitaria e Sociale Regione Emilia Romagna, Bologna, Italy
3Servizio Sovrazonale di Epidemiologia ASL Torino 3, Grugliasco, Italy
4Naples Cancer Registry, ASL Napoli 3 Sud, Brusciano, Italy
5Umbria Cancer Registry, Public Health Department, University of Perugia, Perugia, Italy
6Romagna Cancer Registry, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
7Modena Cancer Registry, Public Health Department AUSL Modena, Modena, Italy
8Trapani Cancer Registry, Health Prevention Department ASL 9 Trapani, Trapani, Italy
9Palermo Cancer Registry, Health Science Department University of Palermo, Palermo, Italy
10Ragusa Cancer Registry, Health Prevention Department ASP Ragusa, Ragusa, Italy
*The Socioeconomic Inequalities and Oncological Outcomes Italian Working Group: Teresa Spadea, Nicolàs Zengarini and Paolo Carnà (Servizio Sovrazonale di Epidemiologia ASL TO3, Grugliasco, Turin); Giuseppe Costa (University of Turin); Milena Sant, Pamela Minicozzi, Francesca Di Salvo, Paolo Baili and Hade Amash (IRCCS Istituto Nazionale dei Tumori Foundation, Milan); Nicola Caranci (Agenzia Sanitaria e Sociale, Regione Emilia-Romagna, Bologna); Adriano Giacomin (Biella Cancer Registry); Alessandro Barchielli and Gianfranco Manneschi (Toscana Cancer Registry), Claudia Cirilli (Modena Cancer Registry); Fabio Falcini, Rosa Vattiato and Alessandra Ravaioli (Romagna Cancer Registry); Lucia Mangone, Paolo Giorgi Rossi, Enza Di Felice and Massimo Vicentini (Reggio Emilia Cancer Registry); Fabio Pannozzo and Francesca Calabretta (Latina Cancer Registry); Fabrizio Stracci, Fortunato Bianconi and Valerio Brunori (Umbria Cancer Registry); Mario Fusco and Valerio Ciullo (Napoli Cancer Registry); Rosaria Cesaraccio (Sassari Cancer Registry); Rosanna Cusimano, Maurizio Zarcone (Palermo Cancer Registry); Rosario Tumino and Carmela Nicita (Ragusa Cancer Registry); Giuseppina Candela and Tiziana Scuderi (Trapani Cancer Registry); Roberto Lillini (Bicocca University, Milan); Marina Vercelli (University of Genova)
Francesca Di Salvo, email: [email protected]
Keywords: deprivation index, census tract, sentinel lymph node biopsy, breast-conserving surgery, cancer registry
Received: December 27, 2016 Accepted: April 26, 2017 Published: July 22, 2017
Background: Socioeconomic factors influence access to cancer care and survival. This study investigated the role of socioeconomic status on the risk of breast cancer recurrence and on the delivery of appropriate cancer care (sentinel lymph node biopsy and breast-conserving surgery plus radiotherapy), by patients’ age and hormone receptor status.
Methods: 3,462 breast cancer cases diagnosed in 2003-2005 were selected from 7 Italian cancer registries and assigned to a socioeconomic tertile on the basis of the deprivation index of their census tract. Multivariable models were applied to assess the delivery of sentinel lymph node biopsy and of breast-conserving surgery plus radiotherapy within socioeconomic tertiles.
Results: In the 1,893 women younger than 65 years, the 5-year risk of recurrence was higher in the most deprived group than in the least deprived, but this difference was not significant (16.4% vs. 12.9%, log-rank p=0.08); no difference was seen in women ≥65 years. Among the 2,024 women with hormone receptor-positive cancer, the 5-year risk was significantly higher in the most deprived group than in the least deprived one (13.0% vs. 8.9%, p=0.04); no difference was seen in cases of hormone receptor-negative cancer. The most deprived women were less likely than the least deprived women to receive sentinel lymph node biopsy (adjusted odds ratio (ORa), 0.69; 95% CI, 0.56-0.86) and to undergo breast-conserving surgery plus radiotherapy (ORa=0.66; 95% CI, 0.51-0.86). Conclusions: Socioeconomic inequalities affect the risk of recurrence, among patients with hormone receptor-positive cancer, and the opportunity to receive standard care.
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