Money counts in breast cancer survival...so does age
Published: 05 July 2011
Better-off patients with breast cancer enjoy a higher survival rate than the poorest ones, according to the Second All Breast Cancer Report published in June by the National Cancer Intelligence Network (NCIN).
Research indicates that women living in poverty tend to be diagnosed at a later stage when the disease has advanced, is too late for surgery or requires more aggressive treatment.
The report provides a unique investigation into how the cancer journey, from diagnosis through either screening or symptom experience presented to a GP, influences the chance of surviving the disease among poor people from disadvantaged and deprived areas with different levels of financial hardship.
Dangers of ignoring screening
For women presenting with symptoms of breast cancer, the report established a 15 per cent difference between the most (68 per cent) and least (83 per cent) deprived in those women who survive for more than five years. However, there was very little difference in survival between the most and least underprivileged women who were diagnosed through screening.
Gill Lawrence, Director of the West Midlands Cancer Intelligence Unit and report author, said: “These figures show that even though a greater number of affluent women develop breast cancer every year, poorer women are more likely to die from the disease. Not going for screening and delays in going to the doctor mean that less affluent women are being diagnosed with later stage cancers which need more invasive surgery and are far less likely to be treated with breast conserving surgery.
“But, if these women attend screening, are breast aware and go to their doctor as soon as they notice anything unusual for them (such as a lump or changes to the nipple like a rash or dimpling), there’s no reason why poorer women shouldn’t have the same chance of survival as more affluent women.”
Improving outcomes
Martin Lee, Chair of the NCIN’s breast clinical reference group and consultant surgeon at University Hospitals Coventry and Warwickshire NHS Trust, said: “Having a more advanced breast cancer at diagnosis is a double blow, as more aggressive treatments are needed and the outlook is worse.
“I know from my own experience with patients that they find it more distressing to cope with the diagnosis if they need both mastectomy and chemotherapy. Fortunately breast screening with mammograms is finding earlier stage cancers that can be controlled by less radical treatments and have better survival; it is particularly encouraging to see that this is narrowing the gap in outcomes between affluent and deprived women.”
And... older patients with breast cancer are less likely to have surgery
Older patients with breast cancer are less likely to have surgery particularly if they are from a deprived area, according to the findings of a study presented at the NCIN conference in June.
Researchers came together from the University of Manchester, University of Leeds, University of York and Hull York Medical School, and from the Northern and Yorkshire Cancer Registry and Information Service (NYCRIS) and the West Midlands Cancer Intelligence Unit (WMCIU) to examine data of more than 23,000 women with breast cancer.
They looked into whether UK women aged over 70 are less likely to have surgery because of other co-morbidities and if, on the whole, older women are less likely to have surgery for breast cancer than younger ones.
Rates for surgery diminished with age and women who had other illnesses were less likely to have surgery. Nevertheless even after accounting for other illnesses the chance of having surgery was still reduced with age – over 85 per cent of women aged 65 to 70 had surgery, 70 per cent in those over 70, and only 50 per cent of the over 80s.
Surgery effective despite age
Dr Katrina Lavelle, lead study author from the University of Manchester, said: “Previous research has shown that older women are less likely to have surgery for breast cancer compared with younger patients. Surgery to remove breast tumours is one of the most effective ways to treat this cancer so it’s important to get a better understanding of what lies behind these differences.
“This research suggests that the presence of other illnesses, which we know increases with age, does not fully explain the difference in treatment between older and younger patients.
Narrowing the age gap
“The good news is that over the time period we looked at, the numbers of women over 65 having surgery did rise from 68 per cent to 75 per cent.
“Our ongoing research, funded by the Breast Cancer Campaign and the National Institute for Health Research, is investigating the extent to which the lack of surgery among older women is due to things like overall frailty or patient choice. We are also developing statistical techniques to help decide which treatment is likely to be the most appropriate based on patient choice, health and acceptable risk, rather than age.”
Steven Oliver, study author from the NYCRIS, said: “This study illustrates the important role the UK’s cancer registry system plays in improving cancer care. By recording the patterns of treatment received by all patients with cancer we have a vital resource that can form the basis for research to understand why care varies.”