Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care

Francesca Di Salvo, Nicola Caranci, Teresa Spadea, Nicolas Zengarini, Pamela Minicozzi, Hade Amash, Mario Fusco, Fabrizio Stracci, Fabio Falcini, Claudia Cirilli, Giuseppina Candela, Rosanna Cusimano, Rosario Tumino, Milena Sant, Socioeconomic Inequalities and Oncological Outcomes Italian Working Group

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Socioeconomic factors influence access to cancer care and survival. This study investigated the role of socioeconomic status on the risk of breast cancer recurrence and on the delivery of appropriate cancer care (sentinel lymph node biopsy and breast-conserving surgery plus radiotherapy), by patients' age and hormone receptor status.

METHODS: 3,462 breast cancer cases diagnosed in 2003-2005 were selected from 7 Italian cancer registries and assigned to a socioeconomic tertile on the basis of the deprivation index of their census tract. Multivariable models were applied to assess the delivery of sentinel lymph node biopsy and of breast-conserving surgery plus radiotherapy within socioeconomic tertiles.

RESULTS: In the 1,893 women younger than 65 years, the 5-year risk of recurrence was higher in the most deprived group than in the least deprived, but this difference was not significant (16.4% vs. 12.9%, log-rank p=0.08); no difference was seen in women ≥65 years. Among the 2,024 women with hormone receptor-positive cancer, the 5-year risk was significantly higher in the most deprived group than in the least deprived one (13.0% vs. 8.9%, p=0.04); no difference was seen in cases of hormone receptor-negative cancer. The most deprived women were less likely than the least deprived women to receive sentinel lymph node biopsy (adjusted odds ratio (ORa), 0.69; 95% CI, 0.56-0.86) and to undergo breast-conserving surgery plus radiotherapy (ORa=0.66; 95% CI, 0.51-0.86). Conclusions: Socioeconomic inequalities affect the risk of recurrence, among patients with hormone receptor-positive cancer, and the opportunity to receive standard care.

Original languageEnglish
Pages (from-to)68402-68414
Number of pages13
JournalOncotarget
Volume8
Issue number40
DOIs
Publication statusPublished - Sep 15 2017

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Standard of Care
Hormones
Breast Neoplasms
Sentinel Lymph Node Biopsy
Segmental Mastectomy
Neoplasms
Radiotherapy
Recurrence
Odds Ratio
Censuses
Social Class
Registries
Survival

Keywords

  • Journal Article

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Di Salvo, F., Caranci, N., Spadea, T., Zengarini, N., Minicozzi, P., Amash, H., ... Socioeconomic Inequalities and Oncological Outcomes Italian Working Group (2017). Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care. Oncotarget, 8(40), 68402-68414. https://doi.org/10.18632/oncotarget.19447

Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care. / Di Salvo, Francesca; Caranci, Nicola; Spadea, Teresa; Zengarini, Nicolas; Minicozzi, Pamela; Amash, Hade; Fusco, Mario; Stracci, Fabrizio; Falcini, Fabio; Cirilli, Claudia; Candela, Giuseppina; Cusimano, Rosanna; Tumino, Rosario; Sant, Milena; Socioeconomic Inequalities and Oncological Outcomes Italian Working Group.

In: Oncotarget, Vol. 8, No. 40, 15.09.2017, p. 68402-68414.

Research output: Contribution to journalArticle

Di Salvo, F, Caranci, N, Spadea, T, Zengarini, N, Minicozzi, P, Amash, H, Fusco, M, Stracci, F, Falcini, F, Cirilli, C, Candela, G, Cusimano, R, Tumino, R, Sant, M & Socioeconomic Inequalities and Oncological Outcomes Italian Working Group 2017, 'Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care', Oncotarget, vol. 8, no. 40, pp. 68402-68414. https://doi.org/10.18632/oncotarget.19447
Di Salvo, Francesca ; Caranci, Nicola ; Spadea, Teresa ; Zengarini, Nicolas ; Minicozzi, Pamela ; Amash, Hade ; Fusco, Mario ; Stracci, Fabrizio ; Falcini, Fabio ; Cirilli, Claudia ; Candela, Giuseppina ; Cusimano, Rosanna ; Tumino, Rosario ; Sant, Milena ; Socioeconomic Inequalities and Oncological Outcomes Italian Working Group. / Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care. In: Oncotarget. 2017 ; Vol. 8, No. 40. pp. 68402-68414.
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abstract = "BACKGROUND: Socioeconomic factors influence access to cancer care and survival. This study investigated the role of socioeconomic status on the risk of breast cancer recurrence and on the delivery of appropriate cancer care (sentinel lymph node biopsy and breast-conserving surgery plus radiotherapy), by patients' age and hormone receptor status.METHODS: 3,462 breast cancer cases diagnosed in 2003-2005 were selected from 7 Italian cancer registries and assigned to a socioeconomic tertile on the basis of the deprivation index of their census tract. Multivariable models were applied to assess the delivery of sentinel lymph node biopsy and of breast-conserving surgery plus radiotherapy within socioeconomic tertiles.RESULTS: In the 1,893 women younger than 65 years, the 5-year risk of recurrence was higher in the most deprived group than in the least deprived, but this difference was not significant (16.4{\%} vs. 12.9{\%}, log-rank p=0.08); no difference was seen in women ≥65 years. Among the 2,024 women with hormone receptor-positive cancer, the 5-year risk was significantly higher in the most deprived group than in the least deprived one (13.0{\%} vs. 8.9{\%}, p=0.04); no difference was seen in cases of hormone receptor-negative cancer. The most deprived women were less likely than the least deprived women to receive sentinel lymph node biopsy (adjusted odds ratio (ORa), 0.69; 95{\%} CI, 0.56-0.86) and to undergo breast-conserving surgery plus radiotherapy (ORa=0.66; 95{\%} CI, 0.51-0.86). Conclusions: Socioeconomic inequalities affect the risk of recurrence, among patients with hormone receptor-positive cancer, and the opportunity to receive standard care.",
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T1 - Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care

AU - Di Salvo, Francesca

AU - Caranci, Nicola

AU - Spadea, Teresa

AU - Zengarini, Nicolas

AU - Minicozzi, Pamela

AU - Amash, Hade

AU - Fusco, Mario

AU - Stracci, Fabrizio

AU - Falcini, Fabio

AU - Cirilli, Claudia

AU - Candela, Giuseppina

AU - Cusimano, Rosanna

AU - Tumino, Rosario

AU - Sant, Milena

AU - Socioeconomic Inequalities and Oncological Outcomes Italian Working Group

PY - 2017/9/15

Y1 - 2017/9/15

N2 - BACKGROUND: Socioeconomic factors influence access to cancer care and survival. This study investigated the role of socioeconomic status on the risk of breast cancer recurrence and on the delivery of appropriate cancer care (sentinel lymph node biopsy and breast-conserving surgery plus radiotherapy), by patients' age and hormone receptor status.METHODS: 3,462 breast cancer cases diagnosed in 2003-2005 were selected from 7 Italian cancer registries and assigned to a socioeconomic tertile on the basis of the deprivation index of their census tract. Multivariable models were applied to assess the delivery of sentinel lymph node biopsy and of breast-conserving surgery plus radiotherapy within socioeconomic tertiles.RESULTS: In the 1,893 women younger than 65 years, the 5-year risk of recurrence was higher in the most deprived group than in the least deprived, but this difference was not significant (16.4% vs. 12.9%, log-rank p=0.08); no difference was seen in women ≥65 years. Among the 2,024 women with hormone receptor-positive cancer, the 5-year risk was significantly higher in the most deprived group than in the least deprived one (13.0% vs. 8.9%, p=0.04); no difference was seen in cases of hormone receptor-negative cancer. The most deprived women were less likely than the least deprived women to receive sentinel lymph node biopsy (adjusted odds ratio (ORa), 0.69; 95% CI, 0.56-0.86) and to undergo breast-conserving surgery plus radiotherapy (ORa=0.66; 95% CI, 0.51-0.86). Conclusions: Socioeconomic inequalities affect the risk of recurrence, among patients with hormone receptor-positive cancer, and the opportunity to receive standard care.

AB - BACKGROUND: Socioeconomic factors influence access to cancer care and survival. This study investigated the role of socioeconomic status on the risk of breast cancer recurrence and on the delivery of appropriate cancer care (sentinel lymph node biopsy and breast-conserving surgery plus radiotherapy), by patients' age and hormone receptor status.METHODS: 3,462 breast cancer cases diagnosed in 2003-2005 were selected from 7 Italian cancer registries and assigned to a socioeconomic tertile on the basis of the deprivation index of their census tract. Multivariable models were applied to assess the delivery of sentinel lymph node biopsy and of breast-conserving surgery plus radiotherapy within socioeconomic tertiles.RESULTS: In the 1,893 women younger than 65 years, the 5-year risk of recurrence was higher in the most deprived group than in the least deprived, but this difference was not significant (16.4% vs. 12.9%, log-rank p=0.08); no difference was seen in women ≥65 years. Among the 2,024 women with hormone receptor-positive cancer, the 5-year risk was significantly higher in the most deprived group than in the least deprived one (13.0% vs. 8.9%, p=0.04); no difference was seen in cases of hormone receptor-negative cancer. The most deprived women were less likely than the least deprived women to receive sentinel lymph node biopsy (adjusted odds ratio (ORa), 0.69; 95% CI, 0.56-0.86) and to undergo breast-conserving surgery plus radiotherapy (ORa=0.66; 95% CI, 0.51-0.86). Conclusions: Socioeconomic inequalities affect the risk of recurrence, among patients with hormone receptor-positive cancer, and the opportunity to receive standard care.

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DO - 10.18632/oncotarget.19447

M3 - Article

C2 - 28978126

VL - 8

SP - 68402

EP - 68414

JO - Oncotarget

JF - Oncotarget

SN - 1949-2553

IS - 40

ER -