Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark

BMC Medicine

Research Article

Bent Ejlertsen¹  Per Damkier²  Cathrine Fonnesbech Hjorth³  Deirdre Cronin-Fenton³  Henrik Toft Sørensen³  Timothy Lash⁴ 

[1] Danish Breast Cancer Group, Blegdamsvej 9, 2100, Copenhagen, Denmark;Department of Oncology, University of Copenhagen, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark;Department of Clinical Biochemistry and Pharmacology, J.B. Winsløvs vej 4, Odense University Hospital, 5000, Odense, Denmark;Department of Clinical Research, Winsløwparken 19, University of Southern Denmark, 5000, Odense, Denmark;Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark;Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark;Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, 30322, Atlanta, GA, USA;

关键词: Socioeconomic position;    Social inequality;    Breast cancer;    Survivorship;    Taxanes;    Docetaxel;    Recurrence;    Mortality;    Survival analyses;   

DOI  :  10.1186/s12916-021-02108-z

 received in 2021-06-15, accepted in 2021-08-26,  发布年份 2021

来源: Springer

【 摘 要 】

BackgroundTo investigate how socioeconomic position (SEP) influences the effectiveness of cancer-directed treatment in premenopausal breast cancer patients in terms of breast cancer recurrence and mortality.MethodsWe conducted a cohort study nested in the ProBeCaRe (Predictors of Breast Cancer Recurrence) cohort (n = 5959). We identified all premenopausal women aged 18–55 years diagnosed with non-metastatic breast cancer and prescribed docetaxel-based chemotherapy in Denmark during 2007–2011. Population-based administrative registries provided data on SEP: marital status (married including registered partnership or single including divorced or widowed), cohabitation (cohabiting or living alone), education (low, intermediate, or high), income (low, medium, or high), and employment status (employed, unemployed, or health-related absenteeism). For each SEP measure, we computed incidence rates, cumulative incidence proportions (CIPs), and used Poisson regression to compute incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of recurrence and death. We stratified on estrogen receptor (ER) status/tamoxifen to evaluate interaction.ResultsOur study cohort included 2616 women; 286 (CIP 13%) experienced recurrence and 223 (CIP 11%) died during follow-up (median 6.6 and 7.2 years, respectively). Single women had both increased 5-year risks of recurrence (IRR 1.45, 95% CI 1.11–1.89) and mortality (IRR 1.83, 95% CI 1.32–2.52). Furthermore, we observed increased 5-year mortality in women with low education (IRR 1.49, 95% CI 0.95–2.33), low income (IRR 1.37, 95% CI 0.83–2.28), unemployment (IRR 1.61, 95% CI 0.83–3.13), or health-related work absenteeism (IRR 1.80, 95% CI 1.14–2.82), but smaller or no increased risk of recurrence. These findings were especially evident among women with ER+ tumors prescribed tamoxifen. Overall analyses (follow-up max. 10 years) provided similar results.ConclusionsLow SEP in premenopausal women with non-metastatic breast cancer was associated with increased mortality, but not always recurrence. This suggests underdetection of recurrences in certain groups. Poor prognosis in women with low SEP, especially single women, may partly be explained by tamoxifen adherence.

【 授权许可】

CC BY   
© The Author(s). 2021

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