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Association between socioeconomic factors at diagnosis and survival in breast cancer: A population-based study.

ABSTRACT: BACKGROUND:The associations between socioeconomic statuses and survival outcomes of breast cancer remain unclear. No model has included both histological and socioeconomic factors to predict the survival of breast cancer. This study was designed to develop nomograms to predict breast cancer-specific survival (BCSS) and overall survival (OS) with consideration of socioeconomic factors for breast cancer patients. MATERIALS AND METHODS:We included a total of 207 749 female patients, diagnosed with malignant breast cancer between 2007 and 2012 from the Surveillance, Epidemiology, and End Results database. BCSS and OS were evaluated with Gray's test and log-rank tests, respectively. Marital statuses, insurance statuses, residence, median household income, poverty rate, unemployment rate, and education level were included as socioeconomic factors in univariate and multivariate Cox regression analyses. Clinicopathological factors and socioeconomic factors were integrated to construct nomograms. Calibration plots and concordance indexes (C-indexes) were used to evaluate the accuracy and discrimination of the models. RESULTS:Four and three socioeconomic factors were involved in constructing the nomograms for 3-, 5-, and 7-year BCSS and OS, respectively. The C-indexes of the final nomograms were higher than those of the TNM staging system for predicting BCSS (0.835 vs 0.782; P < .001) and OS (0.773 vs 0.676; P < .001). The performance of the nomograms for predicting OS was significantly lower when excluding socioeconomic factors (P < .001). CONCLUSION:These findings may highlight the importance of developing health-related policies and the necessity of targeted social support-based interventions for high-risk patients.

SUBMITTER: Ji P

PROVIDER: S-EPMC7050085 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Association between socioeconomic factors at diagnosis and survival in breast cancer: A population-based study.

Ji Peng P Gong Yue Y Jiang Chang-Chuan CC Hu Xin X Di Gen-Hong GH Shao Zhi-Ming ZM

Cancer medicine 20200120 5

<h4>Background</h4>The associations between socioeconomic statuses and survival outcomes of breast cancer remain unclear. No model has included both histological and socioeconomic factors to predict the survival of breast cancer. This study was designed to develop nomograms to predict breast cancer-specific survival (BCSS) and overall survival (OS) with consideration of socioeconomic factors for breast cancer patients.<h4>Materials and methods</h4>We included a total of 207 749 female patients, ...[more]

PMID: 31960597

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Project description:BACKGROUND: Lung and upper aero-digestive tract (UADT) cancer risk are associated with low socioeconomic circumstances and routinely measured using area socioeconomic indices. We investigated effect of country of birth, marital status, one area deprivation measure and individual socioeconomic variables (economic activity, education, occupational social class, car ownership, household tenure) on risk associated with lung, UADT and all cancer combined (excluding non melanoma skin cancer). METHODS: We linked Scottish Longitudinal Study and Scottish Cancer Registry to follow 203,658 cohort members aged 15+ years from 1991-2006. Relative risks (RR) were calculated using Poisson regression models by sex offset for person-years of follow-up. RESULTS: 21,832 first primary tumours (including 3,505 lung, 1,206 UADT) were diagnosed. Regardless of cancer, economically inactivity (versus activity) was associated with increased risk (male: RR 1.14, 95% CI 1.10-1.18; female: RR 1.06, 95% CI 1.02-1.11). For lung cancer, area deprivation remained significant after full adjustment suggesting the area deprivation cannot be fully explained by individual variables. No or non degree qualification (versus degree) was associated with increased lung risk; likewise for UADT risk (females only). Occupational social class associations were most pronounced and elevated for UADT risk. No car access (versus ownership) was associated with increased risk (excluding all cancer risk, males). Renting (versus home ownership) was associated with increased lung cancer risk, UADT cancer risk (males only) and all cancer risk (females only). Regardless of cancer group, elevated risk was associated with no education and living in deprived areas. CONCLUSIONS: Different and independent socioeconomic variables are inversely associated with different cancer risks in both sexes; no one socioeconomic variable captures all aspects of socioeconomic circumstances or life course. Association of multiple socioeconomic variables is likely to reflect the complexity and multifaceted nature of deprivation as well as the various roles of these dimensions over the life course.

Project description:BackgroundMammographic calcifications can be a marker of malignancy, but their association with prognosis is less well established. In the current study, the authors examined the relationship between calcifications and breast cancer prognostic factors in the population-based Carolina Mammography Registry.MethodsThe current study included 8472 invasive breast cancers diagnosed in the Carolina Mammography Registry between 1996 and 2011 for which information regarding calcifications occurring within 2 years of diagnosis was reported. Calcification-specific Breast Imaging Reporting and Data System (BI-RADS) assessments were reported prospectively by a radiologist. Tumor characteristic data were obtained from the North Carolina Central Cancer Registry and/or pathology reports. Multivariable-adjusted associations between the presence of calcifications in the breast affected by cancer and tumor characteristics were estimated using logistic regression. Statistical tests were 2-sided.ResultsThe presence of calcifications was found to be positively associated with tumors that were high grade (vs low grade: odds ratio [OR], 1.43; 95% confidence interval [95% CI], 1.10-1.88) or had an in situ component (vs without: OR, 2.15; 95% CI, 1.81-2.55). Calcifications were found to be inversely associated with hormone receptor-negative status (vs positive status: OR, 0.73; 95% CI, 0.57-0.93), size >35 mm (vs ≤8 mm: OR, 0.47; 95% CI, 0.37-0.61), and lobular tumors (vs ductal: OR, 0.39; 95% CI, 0.22-0.69). The association between the presence of calcifications and an in situ component was limited to BI-RADS category 4 and 5 calcifications and was absent for BI-RADS category 2 or 3 calcifications (P for heterogeneity <.01). The association with tumor size was found to be strongest for BI-RADS categories 3 and 4 (P for heterogeneity <.01).ConclusionsCalcifications were found to be associated with both unfavorable (high grade) and favorable (small size, hormone receptor positivity) prognostic factors. Detailed analysis of the biological features of calcifications is necessary to understand the mechanisms driving these associations. Cancer 2017;123:219-227. © 2016 American Cancer Society.

Project description:PurposeDespite therapeutic advances, overall survival of metastatic breast cancer (MBC) at the population level has seen little improvement over the past decades. Aggressive tumor biology or delay in access to cancer care might be contributing factors. With this retrospective population-based study we aimed to quantify and characterize patients with very short survival time following MBC diagnosis.MethodsWomen diagnosed with MBC between Jan 1st, 2005 and Dec 31st, 2016 were identified using the population-based Stockholm-Gotland breast cancer registry. Data regarding demographic and clinicopathological characteristics, survival, and treatment were extracted retrospectively from the registry and from patient charts. Patients who died within 90 days following diagnosis of MBC were identified and their characteristics were compared with all other patients diagnosed with MBC during the same period.ResultsBetween 2005 and 2016, 3124 patients were diagnosed with MBC, of whom 498 (16.2%) died within 90 days of diagnosis. Nearly half (N = 233) did not receive any antitumoral treatment. Patients with short survival were older (p < 0.001), had higher primary tumor grade (p < 0.001), higher clinical stage at primary diagnosis (p = 0.002), and more often estrogen receptor (ER)-negative breast cancer (p < 0.001). Visceral metastases were more frequent (p < 0.001) and patients with short survival received adjuvant chemotherapy (p < 0.001) to a lesser extent compared to patients with a better prognosis. In multivariable analysis older age, time period of diagnosis, metastasis site, adjuvant chemotherapy, and primary tumor grade were independent predictors for short survival, whereas ER status was not.ConclusionNearly one out of six patients with MBC survive less than 3 months after diagnosis. Our findings demonstrate a different spectrum of MBC at population level and can potentially inform on individualized follow-up strategies and treatment algorithms.

Dataset Information

Association between socioeconomic factors at diagnosis and survival in breast cancer: A population-based study.

Publications

Association between socioeconomic factors at diagnosis and survival in breast cancer: A population-based study.

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