Social class is an important and independent prognostic factor of breast cancer mortality
Social class is an important and independent prognostic factor of breast cancer mortality
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DOI：
10.1002/ijc.21889
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发表时间：
2006-09-01
影响因子：
6.4
通讯作者：
Fioretta, Gerald
中科院分区：
文献类型：
--
作者：
Bouchardy, Christine;Verkooijen, Helena M.;Fioretta, Gerald
社会经济地位对乳腺癌预后的重要影响的原因远未确定。本研究旨在评估和解释乳腺癌的社会差异。瑞士日内瓦州的医疗费用和预期寿命都是世界上最高的。这个这项基于人群的研究包括日内瓦的所有3,920名女性居民，她们在1980年至2000年期间在70岁之前被诊断为浸润性乳腺癌。根据女性的最后一次职业，患者被分为4个社会经济群体。我们使用考克斯多元回归分析来确定乳腺癌生存率中社会经济不平等的原因。与高社会阶层的患者相比，低社会阶层的患者因乳腺癌死亡的风险增加（未校正的风险比[HR] 2.4，95% CI：1.6-3.5）。这些女性更多，通常是外国人，不太经常筛查出癌症，并且在诊断时处于更晚期。她们较少接受保乳手术、激素治疗和化疗，特别是在腋窝淋巴结受累的情况下。当调整所有这些因素时，低社会阶层的患者死于乳腺癌的风险仍显着增加（HR 1.8，95% CI：1.2-2.6）。与低SES相关的高死亡率只能部分解释为延迟诊断，不利的肿瘤特征和次优治疗。本研究未测量的其他因素也可能发挥作用。在等待其他研究结果的同时，我们应考虑社会经济地位作为独立的预后因素，并加强对低社会阶层妇女的支持和监测。(c)2006 Wiley-Liss，Inc.
Reasons of the important impact of socioeconomic status on breast cancer prognosis are far from established. This study aims to evaluate and explain the social disparities in breast cancer. survival in the Swiss canton of Geneva, where healthcare costs and life expectancy are among the highest in the world. This. populationbased study included all 3,920 female residents of Geneva, who were diagnosed with invasive breast cancer before the age of 70 years between 1980 and 2000. Patients were divided into 4 socioeconomic groups, according to the woman's last occupation. We used Cox multivariate regression analysis to identify reasons for the socioeconomic inequalities in breast cancer survival. Compared to patients of high social class, those of low social class had an increased risk (unadjusted hazard ratio [HR] 2.4, 95% CI: 1.6-3.5) of dying as a result of breast cancer. These women were more, often foreigners, less frequently had screen-detected cancer and were at more advanced stage at diagnosis. They less frequently underwent breast-conserving surgery, hormonal therapy, and chemotherapy, in particular, in case of axillary lymph node involvement. When adjusting for all these factors, patients of low social class still had a significantly increased risk of dying of breast cancer (HR 1.8, 95% CI: 1.2-2.6). Overmortality linked to low SES is only partly explained by delayed diagnosis, unfavorable tumor characteristics and suboptimal treatments. Other factors, not measured in this study, also could play a role. While waiting for the outcome of other researches, we should consider socioeconomic status as an independent prognostic factor and provide intensified support and surveillance to women of low social class. (c) 2006 Wiley-Liss, Inc.