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Ulf Gerdtham. Foto.

Ulf Gerdtham

Professor

Ulf Gerdtham. Foto.

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

Författare

  • Adam Lundqvist
  • Emelie Andersson
  • Ida Ahlberg
  • Mef Nilbert
  • Ulf Gerdtham

Summary, in English

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.

Avdelning/ar

  • EpiHealth: Epidemiology for Health
  • Bröstcancer-genetik
  • BioCARE: Biomarkers in Cancer Medicine improving Health Care, Education and Innovation
  • Hälsoekonomi

Publiceringsår

2016-10-01

Språk

Engelska

Sidor

804-813

Publikation/Tidskrift/Serie

European Journal of Public Health

Volym

26

Issue

5

Dokumenttyp

Artikel i tidskrift

Förlag

Oxford University Press

Ämne

  • Public Health, Global Health, Social Medicine and Epidemiology
  • Cancer and Oncology

Status

Published

Forskningsgrupp

  • Health Economics

ISBN/ISSN/Övrigt

  • ISSN: 1101-1262