Poverty and survival of breast cancer in France

Insight

• French women living in the country’s most disadvantaged areas have a 25% worse breast cancer survival rate than those living in the least deprived areas.
• The 5-year survival rate was 88.2% in the poorest areas compared to 92.5% in the least disadvantaged areas, a difference of 4.3 percentage points.
• The differences were greatest in later disease stages at the time of diagnosis.

Why this matters

• The results are worrying because universal access to cancer care in France should balance the gap between rich and poor.
• In addition, the results suggest that poorer women are diagnosed in later stages of the disease.

Study design

• Women with newly diagnosed breast cancer (n=12,738) from 2008 to 2015 in 2 regions of France covered by the Loire-Atlantique and Vendee cancer registries were examined.
• Deprivation areas were determined on the basis of the French European Deprivation Index (quintiles 1-5, 5 being the most disadvantaged areas).
• Primary endpoint: 5-year survival rate for breast cancer.
• Funding: French National Cancer Institute; French Ministry of Health; Institute of Health and Medical Research.

Key results

• After adjusting for disease stage, women living in the most disadvantaged areas had a 25% (95% CI -3% to 62%) worse survival rate:
  • The 5-year net survival rate was 88.2% (95% CI 85.2%-90.5%) in the most disadvantaged quintile (quintile 5) and 92.5% (95% CI 90.6%-93.9%) in the least disadvantaged quintile (quintile 1).
  • The effect was similar in all age groups.
• Disease stage at diagnosis had a strong impact, with excess mortality increasing with higher stage at diagnosis:
  • At stage 1 at diagnosis, the difference was negligible, with 5-year net survival of 99.4% in quintile 1 and 99.3% in quintile 5.
  • At stage 2 at diagnosis, the difference was also negligible, with a 5-year net survival of 93.2% in quintile 1 and 91.2% in quintile 5.
  • In stage 3 at diagnosis, the difference was greater, with 5-year net survival of 80.5% in quintile 1 and 72.7% in quintile 5.
  • The difference was greatest in stage 4 at diagnosis, with 5-year net survival of 32.0% in quintile 1 and 22.8% in quintile 5.

• The 5-year net survival rate was 88.2% (95% CI 85.2%-90.5%) in the most disadvantaged quintile (quintile 5) and 92.5% (95% CI 90.6%-93.9%) in the least disadvantaged quintile (quintile 1).
• The effect was similar in all age groups.

• At stage 1 at diagnosis, the difference was negligible, with 5-year net survival of 99.4% in quintile 1 and 99.3% in quintile 5.
• At stage 2 at diagnosis, the difference was also negligible, with a 5-year net survival of 93.2% in quintile 1 and 91.2% in quintile 5.
• In stage 3 at diagnosis, the difference was greater, with 5-year net survival of 80.5% in quintile 1 and 72.7% in quintile 5.
• The difference was greatest in stage 4 at diagnosis, with 5-year net survival of 32.0% in quintile 1 and 22.8% in quintile 5.

Restrictions

• Observational study with ecological design.
• The results may not be transferable to other countries.

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Source — https://www.univadis.de/viewarticle/armut-und-uberleben-von-brustkrebs-in-frankreich