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Epidemiology

Is survival rate lower after breast cancer in deprived women according to disease stage?

British Journal of Cancer volume 128, pages 63–70 (2023)Cite this article

Subjects

Abstract

Background

Socioeconomic deprivation has been associated with lower breast cancer (BC) survival, but the influence of stage at diagnosis on this association merits further study. Our aim was to investigate this association using the Loire-Atlantique/Vendee Cancer Registry (France).

Methods

Twelve-thousand seven-hundred thirty-eight women living in the area covered by the registry and diagnosed with invasive breast carcinoma between 2008 and 2015 were included in the study. They were censored at maximal 6 years. Deprivation was measured by the French European Deprivation Index. Excess hazard and net survival were estimated for deprivation level, stage and age at diagnosis using a flexible excess mortality hazard model.

Results

After adjustment by stage, women living in the most deprived areas had a borderline non-significant higher excess mortality hazard (+25% (95% CI: −3%; +62%)) compared to those living in the least deprived areas. Stage-adjusted 5-year net survival differed significantly between these two subgroups (respectively, 88.2% (95% CI:85.2%-90.5%) and 92.5% (95% CI:90.6%-93.9%)).

Conclusion

BC survival remained lower in deprived areas in France, despite universal access to cancer care. Intensification of prevention measures could help to reduce advanced BC, responsible for the majority of deaths from BC. A better understanding of remaining social disparities is crucial to implement specific interventions.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank those who provided data to the registry: pathologists (CHD Vendée, CH Saint-Nazaire, CHU Nantes, IHP group, Kerlo-Morin laboratory, CRLCC Nantes-Angers, CHU Angers, laboratories from Ille-et-Vilaine and Nouvelle-Aquitaine), oncologists, public and private hospital medical data processing departments, and medical practitioners as well as the medical departments of the national health insurance programmes, the screening coordination centre and Cancer Regional Network. We would like to thank ERISC/MapInMed platform (French national methodological platform for the study and reduction of health social inequalities in oncology) for the attribution of F-EDI value.

Funding

This work was prepared within the framework of the SIRIC ILIAD programme supported by the French National Cancer Institute (INCa), the French Ministry of Health, and the Institute of Health and Medical Research (INSERM); SIRIC ILIAD INCa-DGOS-Inserm_12558 grant. The Loire-Atlantique/Vendee Cancer Registry is supported for the routine collection of data by the French National Cancer Institute (INCa), Santé Publique France, Direction Générale de l’Offre de Soins (DGOS), local institutions (Conseil Régional des Pays de la Loire, ARS des Pays de la Loire, CHU Nantes, CHD Vendée, Institut de Cancérologie de l’Ouest) and the League Against Cancer (comités de Loire-Atlantique et de Vendée).

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Authors and Affiliations

  1. Loire-Atlantique/Vendée Cancer Registry, Nantes, France

    Claire Delacôte, Solenne Delacour-Billon, Stéphanie Ayrault-Piault, Anne-Delphine Tagri, Gwenaëlle Rousseau, Mélissa Vincent, Sophie Amossé, Anne Cowppli-Bony & Florence Molinié

  2. SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France

    Claire Delacôte, Anne Cowppli-Bony & Florence Molinié

  3. SIRIC ILIAD INCa-DGOS-Inserm_12558, Angers, France

    Claire Delacôte, Anne Cowppli-Bony & Florence Molinié

  4. French Network of Cancer Registries (FRANCIM), Toulouse, France

    Solenne Delacour-Billon, Stéphanie Ayrault-Piault, Anne Cowppli-Bony & Florence Molinié

  5. CERPOP, UMR 1295, Université Toulouse III, Inserm, Equipe EQUITY, Toulouse, France

    Cyrille Delpierre, Anne Cowppli-Bony & Florence Molinié

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  1. Claire Delacôte
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Contributions

FM, ACB had the idea for the study. C Delacôte, SD, SAY, ACB, FM contributed to the conception and design of the analysis. ADT, GR, MV, SA collected the data. C Delacôte performed the analysis. C Delacôte, SD, SAY, C Delpierre, ACB, FM contributed to the interpretation. The first draft of the work was written by C Delacôte and all authors commented on previous versions of the manuscript. All authors revised the manuscript critically for important intellectual content and approved the final version for publication. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Claire Delacôte.

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Competing interests

The authors declare no competing interests.

Ethical approval and consent to participate

This study is based on data from the Loire-Atlantique/Vendee Cancer Registry, a member of the French network of cancer registries (FRANCIM). It has received the approval of the French regulatory authorities for the collection and analysis of medical data: the Comité Consultatif sur le Traitement de l’Information en matière de Recherche dans le Domaine de la Santé (ethical approval) and the Commission Nationale Informatique et Libertés (legal framework and data protection). In conformity with French law, patients were informed individually of the nature of the information provided, the purpose of data processing, their right of access, rectification and objection. The ethics committee, in accordance with French law, did not request informed consent. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or a comparable ethical standard. All methods were performed in accordance with the relevant guidelines and regulations.

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Delacôte, C., Delacour-Billon, S., Ayrault-Piault, S. et al. Is survival rate lower after breast cancer in deprived women according to disease stage?. Br J Cancer 128, 63–70 (2023). https://doi.org/10.1038/s41416-022-02024-w

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