Evaluation of the association of area-level socioeconomic deprivation and breast cancer recurrence by oestrogen receptor subtypes in Scotland

Hayley M Dunlop; Linda J Williams; Peter S Hall; Matthew Barber; Christine Dodds; Jonine D Figueroa

doi:10.1186/s13058-023-01704-6

Evaluation of the association of area-level socioeconomic deprivation and breast cancer recurrence by oestrogen receptor subtypes in Scotland

Breast Cancer Res. 2023 Oct 3;25(1):106. doi: 10.1186/s13058-023-01704-6.

Authors

Hayley M Dunlop¹, Linda J Williams², Peter S Hall³, Matthew Barber⁴, Christine Dodds⁵, Jonine D Figueroa^{6

7}

Affiliations

¹ The Ohio State University College of Medicine, Columbus, OH, USA.
² Edinburgh Clinical Trials Unit, The Usher Institute, The University of Edinburgh, Edinburgh, EH16 4UX, UK.
³ Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
⁴ Edinburgh Breast Unit, NHS Lothian, Western General Hospital, Edinburgh, UK.
⁵ Southeast Scotland Cancer Network (SCAN), Edinburgh, UK.
⁶ Centre for Global Health, The Usher Institute, The University of Edinburgh, Edinburgh, EH8 9AG, UK. jonine.figueroa@nih.gov.
⁷ Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. jonine.figueroa@nih.gov.

Abstract

Background: Women from socioeconomically deprived areas have lower breast cancer (BC) incidence rates for screen-detected oestrogen receptor (ER) + tumours and higher mortality for select tumour subtypes. We aimed to determine if ipsilateral breast cancer recurrence (IBR) differs by Scottish Index of Multiple Deprivation (SIMD) quintile and tumour subtype in Scotland.

Methods: Patient data for primary invasive BC diagnosed in 2007-2008 in Scotland was analysed. Manual case-note review for 3495 patients from 10 years post-diagnosis was used. To determine the probability of IBR while accounting for the competing risk of death from any cause, cumulative incidence functions stratified by ER subtype and surgery were plotted. Multivariable Cox Proportional Hazards models were used to estimate the association of SIMD accounting for other predictors of IBR.

Results: Among 2819 ER + tumours, 423 patients had a recurrence and 438 died. SIMD was related to death (p = 0.018) with the most deprived more likely to have died in the 10-year period (17.7% vs. 12.9%). We found no significant differences by SIMD in prognostic tumour characteristics (grade, TNM stage, treatment, screen-detection) or risk of IBR. Among 676 patients diagnosed with ER- tumours, 105 died and 185 had a recurrence. We found no significant differences in prognostic tumour characteristics by SIMD except screen detection with the most deprived more likely than the least to have their tumours detected from screening (46.9% vs. 28%, p = 0.03). Among patients with ER- tumours, 50% had mastectomy and the most deprived had increased 5-year IBR risk compared to the least deprived (HR 3.03 [1.41-6.53]).

Conclusions: IBR is not a major contributor to mortality differences by SIMD for the majority of BC patients in our study. The lack of inequities in IBR are likely due to standardised treatment protocols and access to healthcare. The association with socioeconomic deprivation and recurrence for ER- tumours requires further study.

Keywords: Breast cancer; Disparities; Recurrence.

Publication types

Research Support, N.I.H., Intramural

MeSH terms

Breast / pathology
Breast Neoplasms* / pathology
Female
Humans
Mastectomy
Receptors, Estrogen
Socioeconomic Factors

Substances

Receptors, Estrogen