1. Prognostic factors for breast cancer survival in affluent and deprived areas Jasmina Stefoski-Mikeljevic

2. Background Survival from breast cancer is improving due to earlier diagnosis and better treatments Survival breast cancer linked to socio- economic status (SES) SES differences in survival consistent throughout 1980s and 1990s Multi-factorial reasons tumour biology (ER)other tumour characteristics comorbidityadjuvant treatments type of surgery

3. SES related survival (Yorkshire) 10-year survival for 1990-1993 (8% difference at 5 years) 5-year survival for 1994-1997 (11% difference)

4. Study Aim Identify prognostic factors that may be determinants of SES difference in breast cancer survival in Northern and Yorkshire Factors examined: age, stage*, type of adjuvant treatment received (CT, RT, Hormone), type of surgery, GP and hospital delay Methods Retrospective population-based study Female breast cancer patients diagnosed between 1998-2000 in the area covered by the Northern and Yorkshire Cancer Registry (n=12,880) Townsend deprivation index * 9% of cases with unknown stage

5. Age at diagnosis by SES p< 0.00001

6. Stage at diagnosis by SES Likelihood of stage I UnadjustedAge adjusted Affluent111 20.95 (0.85-1.05)0.95 (0.84-1.07) 30.82 (0.74-0.91)0.89 (0.79-1.00) Deprived40.79 (0.71-0.87)0.84 (0.75-0.95)

7. BCS by SES p< 0.00001

8. RT by SES p< 0.00001

9. Multiple regression analyses (1) Surgery 20.890.77-1.020.820.66-1.02 30.620.54-0.710.740.60-0.91 Any Surgery * 40.540.47-0.610.620.50-0.76 OR 95% CI OR 95% CI Unadjust. Adjusted * Adjusted for age, stage, GP and hospital delay dep aff dep

10. Multiple regression analyses (2) Adjuvant therapy 20.910.82-1.000.940.82-1.06 30.740.67-0.810.860.75-0.98 RT 40.690.62-0.760.820.72-0.93 *Adjusted for age, stage, other adjuvant therapies, type of surgery, GP and hospital delay OR 95% CI OR 95% CI Unadjust. Adjusted* aff dep

11. Multiple regression analyses (3) GP and hospital delay (>14 days) * Adjusted for age, stage OR95% CI OR 95% CI Unadjust. Adjusted* aff dep

12. Conclusions Differences between affluent and poor breast cancer patients in -age -stage -type of surgery and RT rates -waiting times for hospital appointment and start of treatment In addition to already identified factors, poorer survival of breast cancer patients from deprived areas is also likely to be explained by a combination of the the above factors ie. older age, more advanced stage, less surgical treatment, less RT, and longer waits for hospital appointment and start of first treatment

13. K PrakashUniversity of Leeds C Craigs NYCRIS D Forman NYCRIS & Uni of Leeds R Haward NYCRIS & Uni of Leeds Acknowledgements

14. The Study Population 1, 553 patients diagnosed in Yorkshire between 1995 and 2000 50 cases excluded (treated outside the region and rare types ) Total number of cases: 1,503

15. Study Population by Age and Stage AgeNo. % <4051234.1 40-5952034.6 60-7425917.2 75+21214.1 Median age 46 years 25.4% 64+ years old (~40% of all deaths) StageNo.% I85256.7 II30220.1 III19012.6 IV 77 5.1 Unknown 82 5.5

16. Conclusions Stage at diagnosis is related to patients’ age and socio-economic profile Treatment pattern of cervical cancer patients during the study period (1995-2000) was in line with what is now considered good management practice recommended in the national guidelines published in 1999 Survival is influenced by patients’ age and stage, and not by their socio-economic status Patients managed by higher workload gynaecologists have better survival