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

doi:10.1007/s10549-022-06632-1

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 journal › Article › peer-review

Abstract

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 language	English
Pages (from-to)	463-473
Journal	Breast cancer research and treatment
Volume	194
Issue number	2
Early online date	1 Jun 2022
DOIs	https://doi.org/10.1007/s10549-022-06632-1
Publication status	Published - 1 Jun 2022

Keywords

Breast Neoplasms
Educational Status
Female
Humans
Incidence
Income
Poverty
Socioeconomic Factors

Access to Document

10.1007/s10549-022-06632-1Licence: Creative Commons: Attribution (CC-BY)

Mesa-Eguiagaray2022_Article_BreastCancerIncidenceAndSurvivFinal published version, 1.22 MBLicence: Creative Commons: Attribution (CC-BY)

https://link.springer.com/10.1007/s10549-022-06632-1Licence: Creative Commons: Attribution (CC-BY)

Embargoed Document

Manuscript_AAM
Accepted author manuscript, 1.8 MB
Licence: Creative Commons: Attribution (CC-BY)
Embargo ends: 1/06/23

Cite this

@article{26269d83a6cf4cbd990725039b6d6106,

title = "Breast cancer incidence and survival in Scotland by socio-economic deprivation and tumour subtype",

abstract = "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 andmode of detection in Scotland are unknown.Methods Data consisted of 62,378 women diagnosed with invasive BC between 2000 and 2016 in Scotland. Incidencerates and time trends were calculated for oestrogen receptor positive (ER+) and negative (ER−) tumours and stratified bythe Scottish Index of Multiple Deprivation (SIMD) quintiles and screening status. SIMD is an area-based measure derivedacross seven domains: income, employment, education, health, access to services, crime and housing. We calculated adjustedhazard ratios (aHR [95% confidence intervals]) for BC death by immunohistochemical surrogates of molecular subtypes forthe 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 fornon-screen-detected ER+tumours or ER− tumours by deprivation. BC mortality was higher in the most compared to the leastdeprived 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 notstatistically significant.Conclusions Deprivation is associated with differential BC incidence trends for screen-detected ER+tumours and with highermortality for select tumour subtypes. Future efforts should evaluate factors that might be associated with reduced survivalin deprived populations and monitor progress stratified by tumour subtypes and mode of detection",

keywords = "Breast Neoplasms, Educational Status, Female, Humans, Incidence, Income, Poverty, Socioeconomic Factors",

author = "Ines Mesa-eguiagaray and Wild, {Sarah H.} and Bird, {Sheila M.} and Williams, {Linda J.} and Brewster, {David H.} and Hall, {Peter S.} and Figueroa, {Jonine D.}",

note = "Funding Information: This project was funded by Wellcome Trust Grant 207800/Z/17/Z. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = jun,

day = "1",

doi = "10.1007/s10549-022-06632-1",

language = "English",

volume = "194",

pages = "463--473",

journal = "Breast cancer research and treatment",

issn = "0167-6806",

publisher = "Springer New York",

number = "2",

}

TY - JOUR

T1 - Breast cancer incidence and survival in Scotland by socio-economic deprivation and tumour subtype

AU - Mesa-eguiagaray, Ines

AU - Wild, Sarah H.

AU - Bird, Sheila M.

AU - Williams, Linda J.

AU - Brewster, David H.

AU - Hall, Peter S.

AU - Figueroa, Jonine D.

PY - 2022/6/1

Y1 - 2022/6/1

N2 - 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 andmode of detection in Scotland are unknown.Methods Data consisted of 62,378 women diagnosed with invasive BC between 2000 and 2016 in Scotland. Incidencerates and time trends were calculated for oestrogen receptor positive (ER+) and negative (ER−) tumours and stratified bythe Scottish Index of Multiple Deprivation (SIMD) quintiles and screening status. SIMD is an area-based measure derivedacross seven domains: income, employment, education, health, access to services, crime and housing. We calculated adjustedhazard ratios (aHR [95% confidence intervals]) for BC death by immunohistochemical surrogates of molecular subtypes forthe 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 fornon-screen-detected ER+tumours or ER− tumours by deprivation. BC mortality was higher in the most compared to the leastdeprived 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 notstatistically significant.Conclusions Deprivation is associated with differential BC incidence trends for screen-detected ER+tumours and with highermortality for select tumour subtypes. Future efforts should evaluate factors that might be associated with reduced survivalin deprived populations and monitor progress stratified by tumour subtypes and mode of detection

AB - 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 andmode of detection in Scotland are unknown.Methods Data consisted of 62,378 women diagnosed with invasive BC between 2000 and 2016 in Scotland. Incidencerates and time trends were calculated for oestrogen receptor positive (ER+) and negative (ER−) tumours and stratified bythe Scottish Index of Multiple Deprivation (SIMD) quintiles and screening status. SIMD is an area-based measure derivedacross seven domains: income, employment, education, health, access to services, crime and housing. We calculated adjustedhazard ratios (aHR [95% confidence intervals]) for BC death by immunohistochemical surrogates of molecular subtypes forthe 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 fornon-screen-detected ER+tumours or ER− tumours by deprivation. BC mortality was higher in the most compared to the leastdeprived 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 notstatistically significant.Conclusions Deprivation is associated with differential BC incidence trends for screen-detected ER+tumours and with highermortality for select tumour subtypes. Future efforts should evaluate factors that might be associated with reduced survivalin deprived populations and monitor progress stratified by tumour subtypes and mode of detection

KW - Breast Neoplasms

KW - Educational Status

KW - Female

KW - Humans

KW - Incidence

KW - Income

KW - Poverty

KW - Socioeconomic Factors

U2 - 10.1007/s10549-022-06632-1

DO - 10.1007/s10549-022-06632-1

M3 - Article

C2 - 35648299

VL - 194

SP - 463

EP - 473

JO - Breast cancer research and treatment

JF - Breast cancer research and treatment

SN - 0167-6806

IS - 2

ER -

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

Abstract

Keywords

Access to Document

Embargoed Document

Fingerprint

Cite this