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Socioeconomic inequalities in breast cancer incidence and mortality in Europe - A systematic review and meta-analysis

Lundqvist, Adam; Andersson, Emelie LU ; Ahlberg, Ida; Nilbert, Mef LU and Gerdtham, Ulf LU (2016) In European Journal of Public Health 26(5). p.804-813
Abstract

Background: Breast cancer is the leading cause of female cancer in Europe and is estimated to affect more than one in 10 women. Higher socioeconomic status has been linked to higher incidence but lower case fatality, while the impact on mortality is ambiguous. Methods: We performed a systematic literature review and meta-analysis on studies on association between socioeconomic status and breast cancer outcomes in Europe, with a focus on effects of confounding factors. Summary relative risks (SRRs) were calculated. Results: The systematic review included 25 articles of which 8 studied incidence, 10 case fatality and 8 mortality. The meta-analysis showed a significantly increased incidence (SRR 1.25, 1.17-1.32), a significantly decreased... (More)

Background: Breast cancer is the leading cause of female cancer in Europe and is estimated to affect more than one in 10 women. Higher socioeconomic status has been linked to higher incidence but lower case fatality, while the impact on mortality is ambiguous. Methods: We performed a systematic literature review and meta-analysis on studies on association between socioeconomic status and breast cancer outcomes in Europe, with a focus on effects of confounding factors. Summary relative risks (SRRs) were calculated. Results: The systematic review included 25 articles of which 8 studied incidence, 10 case fatality and 8 mortality. The meta-analysis showed a significantly increased incidence (SRR 1.25, 1.17-1.32), a significantly decreased case fatality (SRR 0.72, 0.63-0.81) and a significantly increased mortality (SRR 1.16, 1.10-1.23) for women with higher socioeconomic status. The association for incidence became insignificant when reproductive factors were included. Case fatality remained significant after controlling for tumour characteristics, treatment factors, comorbidity and lifestyle factors. Mortality remained significant after controlling for reproductive factors. Conclusion: Women with higher socioeconomic status show significantly higher breast cancer incidence, which may be explained by reproductive factors, mammography screening, hormone replacement therapy and lifestyle factors. Lower case fatality for women with higher socioeconomic status may be partly explained by differences in tumour characteristics, treatment factors, comorbidity and lifestyle factors. Several factors linked to breast cancer risk and outcome, such as lower screening attendance for women with lower socioeconomic status, are suitable targets for policy intervention aimed at reducing socioeconomic-related inequalities in health outcomes.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Public Health
volume
26
issue
5
pages
10 pages
publisher
Oxford University Press
external identifiers
  • scopus:84992390011
  • wos:000386451800018
ISSN
1101-1262
DOI
10.1093/eurpub/ckw070
language
English
LU publication?
yes
id
88152fdc-cbd5-4164-84f0-d5eac5793157
date added to LUP
2016-11-16 11:18:35
date last changed
2017-11-19 04:34:52
@article{88152fdc-cbd5-4164-84f0-d5eac5793157,
  abstract     = {<p>Background: Breast cancer is the leading cause of female cancer in Europe and is estimated to affect more than one in 10 women. Higher socioeconomic status has been linked to higher incidence but lower case fatality, while the impact on mortality is ambiguous. Methods: We performed a systematic literature review and meta-analysis on studies on association between socioeconomic status and breast cancer outcomes in Europe, with a focus on effects of confounding factors. Summary relative risks (SRRs) were calculated. Results: The systematic review included 25 articles of which 8 studied incidence, 10 case fatality and 8 mortality. The meta-analysis showed a significantly increased incidence (SRR 1.25, 1.17-1.32), a significantly decreased case fatality (SRR 0.72, 0.63-0.81) and a significantly increased mortality (SRR 1.16, 1.10-1.23) for women with higher socioeconomic status. The association for incidence became insignificant when reproductive factors were included. Case fatality remained significant after controlling for tumour characteristics, treatment factors, comorbidity and lifestyle factors. Mortality remained significant after controlling for reproductive factors. Conclusion: Women with higher socioeconomic status show significantly higher breast cancer incidence, which may be explained by reproductive factors, mammography screening, hormone replacement therapy and lifestyle factors. Lower case fatality for women with higher socioeconomic status may be partly explained by differences in tumour characteristics, treatment factors, comorbidity and lifestyle factors. Several factors linked to breast cancer risk and outcome, such as lower screening attendance for women with lower socioeconomic status, are suitable targets for policy intervention aimed at reducing socioeconomic-related inequalities in health outcomes.</p>},
  author       = {Lundqvist, Adam and Andersson, Emelie and Ahlberg, Ida and Nilbert, Mef and Gerdtham, Ulf},
  issn         = {1101-1262},
  language     = {eng},
  month        = {10},
  number       = {5},
  pages        = {804--813},
  publisher    = {Oxford University Press},
  series       = {European Journal of Public Health},
  title        = {Socioeconomic inequalities in breast cancer incidence and mortality in Europe - A systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1093/eurpub/ckw070},
  volume       = {26},
  year         = {2016},
}