Inequalities matter in health. One of our goals as a charity is to help ensure that everyone in the UK – no matter what their background or where they live – has equal access to the best treatment for cancer. But the evidence shows that people from different backgrounds have different cancer outcomes. The big question is – why?
A new analysis of breast cancer survival rates, published today by the National Cancer Intelligence Network (NCIN), suggests that spotting cancer early may be one of the key reasons.
The ‘All Breast Cancer’ report (PDF) is a comprehensive analysis of women with breast cancer. Its authors collated in-depth data on a wide range of factors, including how long women survived, how they were diagnosed, and their socio-economic background.
To make things easy to compare, they divided the women into five groups, ranging from the least deprived (or affluent) to the most deprived.
The report’s key finding is illustrated here:
Click to enlarge
Among women diagnosed via the national breast cancer screening programmes across the UK, their background was almost irrelevant. There was very little difference in the percentage of women who survived their disease for at least five years (99 per cent among the most well-off group, against 94 per cent of the least well-off fifth).
But among women who were diagnosed in other ways – for example by finding a lump themselves and going to see a doctor – there was a stark difference. Just 68 per cent of the poorest women survived their breast cancer for at least five years, compared with 83 per cent of the most affluent.
(It’s worth noting that the ‘diagnosed by other routes’ group contained a wider age range than the ‘diagnosed by screening’ group, which may have had an effect on the results).
This difference means two things.
Firstly, it suggests that women from the most deprived backgrounds who don’t attend screening, but who go on to develop breast cancer, are probably being diagnosed at a later stage, when treatment is less likely to be as successful. This could be for a number of reasons, including lower awareness of symptoms or being more hesitant about seeing the doctor.
Secondly, it shows how important screening is in detecting cancers early. Making sure women from all backgrounds are aware of the potential benefits of breast screening is crucial. We need to redouble our efforts to make sure as many women as possible have access to appropriate information about screening.
Breast cancer is one of the success stories of recent years. Survival rates are improving, death rates are falling, and treatments have improved. We need to make sure that everyone benefits from the hard work of our doctors and researchers.
Henry
Comments
Clare Moynihan June 9, 2011
This is very interesting. We in the behavioural and psycho-social field of cancer have not and do not take enough notice of social class and other variables related to behaviour and attitudes re breast (and other types of cancer!). Women who go to screening for breast cancer may experience the benefit of anonymity in relation to technology, the venue (sometimes in a van) and the way interaction with health professionals can be kept to a minimum. This may especially (but not exclusively) be the case for women who do not speak English, working class women of all ages(?) who may be intimidated by the whole ‘machinery’ of Western medicine. Diagnosis through ‘other’ avenues may mean that women including those in lower socio economic groups are put off’ by the relational aspect of going to health professionals. Much more needs to be known about this aspect of contact; about gender, class, age, ethnicity and so on, not only re potential patients but health professionals too. This needs careful, multi methodological investigations by researchers who are not necessarily partial to a ‘medical model’ of disease! The work of Mildred Blaxter is useful here although she did not enter the cancer field, and many others who have investigated socio economic status and the way the latter relates to behaviour and attitudes in relation to health and illness.
Henry Scowcroft June 10, 2011
Really interesting comment, thanks Clare!