Breast cancer incidence and survival in Scotland by socio-economic deprivation and tumour subtype

Ines Mesa-eguiagaray, Sarah H. Wild, Sheila M. Bird, Linda J. Williams, David H. Brewster, Peter S. Hall, Jonine D. Figueroa

Research output: Contribution to journalArticlepeer-review


Background Women from socio-economically deprived areas are less likely to develop and then to survive breast cancer
(BC). Whether associations between deprivation and BC incidence and survival differ by tumour molecular subtypes and
mode of detection in Scotland are unknown.
Methods Data consisted of 62,378 women diagnosed with invasive BC between 2000 and 2016 in Scotland. Incidence
rates and time trends were calculated for oestrogen receptor positive (ER+) and negative (ER−) tumours and stratified by
the Scottish Index of Multiple Deprivation (SIMD) quintiles and screening status. SIMD is an area-based measure derived
across seven domains: income, employment, education, health, access to services, crime and housing. We calculated adjusted
hazard ratios (aHR [95% confidence intervals]) for BC death by immunohistochemical surrogates of molecular subtypes for
the most versus the least deprived quintile. We adjusted for mode of detection and other confounders.
Results In Scotland, screen-detected ER+tumour incidence increased over time, particularly in the least deprived quintile
[Average Annual Percentage Change (AAPC)= 2.9% with 95% CI from 1.2 to 4.7]. No marked differences were observed for
non-screen-detected ER+tumours or ER− tumours by deprivation. BC mortality was higher in the most compared to the least
deprived quintile irrespective of ER status (aHR= 1.29 [1.18, 1.41] for ER+ and 1.27 [1.09, 1.47] for ER− tumours). How-
ever, deprivation was associated with significantly higher mortality for luminal A and HER2−enriched tumours (aHR= 1.46
[1.13, 1.88] and 2.10 [1.23, 3.59] respectively) but weaker associations for luminal B and TNBC tumours that were not
statistically significant.
Conclusions Deprivation is associated with differential BC incidence trends for screen-detected ER+tumours and with higher
mortality for select tumour subtypes. Future efforts should evaluate factors that might be associated with reduced survival
in deprived populations and monitor progress stratified by tumour subtypes and mode of detection
Original languageEnglish
Pages (from-to)463-473
JournalBreast cancer research and treatment
Issue number2
Early online date1 Jun 2022
Publication statusPublished - 1 Jun 2022


  • Breast Neoplasms
  • Educational Status
  • Female
  • Humans
  • Incidence
  • Income
  • Poverty
  • Socioeconomic Factors


Dive into the research topics of 'Breast cancer incidence and survival in Scotland by socio-economic deprivation and tumour subtype'. Together they form a unique fingerprint.

Cite this