Original Article

Socioeconomic status and survival after an invasive breast cancer diagnosis

  1. Brian L. Sprague PhD1,†,‡,§,*,
  2. Amy Trentham-Dietz PhD1,2,
  3. Ronald E. Gangnon PhD1,2,3,
  4. Ritesh Ramchandani BS3,
  5. John M. Hampton MS1,
  6. Stephanie A. Robert PhD, MSW4,
  7. Patrick L. Remington MD, PhD1,2,
  8. Polly A. Newcomb PhD1,5

Article first published online: 8 NOV 2010

DOI: 10.1002/cncr.25589

Issue

Cancer

Cancer

Volume 117, Issue 7, pages 1542–1551, 1 April 2011

Additional Information

How to Cite

Sprague, B. L., Trentham-Dietz, A., Gangnon, R. E., Ramchandani, R., Hampton, J. M., Robert, S. A., Remington, P. L. and Newcomb, P. A. (2011), Socioeconomic status and survival after an invasive breast cancer diagnosis. Cancer, 117: 1542–1551. doi: 10.1002/cncr.25589

Author Information

  1. 1

    University of Wisconsin Carbone Cancer Center, Madison, Wisconsin

  2. 2

    Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin

  3. 3

    Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin

  4. 4

    School of Social Work, University of Wisconsin, Madison, Wisconsin

  5. 5

    Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington

  1. †

    Department of Surgery, University of Vermont, Burlington, Vermont, and Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin

  1. ‡

    Fax: (802) 656-8826

  2. §

    We are grateful to Drs. Kathleen Egan, Linda Titus-Ernstoff, Henry Anderson, and Jane McElroy for study-related advice; to Laura Stephenson and the staff of the Wisconsin Cancer Reporting System; and to Julie McGregor, Kathy Peck, Mary Pankratz, Linda Haskins, and Jerry Phipps along with the study interviewers for assistance with data collection.

*Office of Health Promotion Research, 1 South Prospect Street, Rm 4428B, Burlington, VT 05401

Publication History

  1. Issue published online: 18 MAR 2011
  2. Article first published online: 8 NOV 2010
  3. Manuscript Accepted: 20 JUL 2010
  4. Manuscript Revised: 28 JUN 2010
  5. Manuscript Received: 3 MAY 2010

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Keywords:

  • breast neoplasms;
  • healthcare disparities;
  • socioeconomic factors;
  • epidemiologic studies;
  • survival analysis

The authors of this report examined both individual-level and community-level socioeconomic status in relation to breast cancer survival in a population-based cohort. The results indicated that early detection with mammography may account for most of the substantial disparity in survival according to income; however, disparities by education level could not be explained fully by variation in early detection and lifestyle factors.

Abstract

BACKGROUND:

Women who live in geographic areas with high poverty rates and low levels of education experience poorer survival after a breast cancer diagnosis than women who live in communities with indicators of high socioeconomic status (SES). However, very few studies have examined individual-level SES in relation to breast cancer survival or have assessed the contextual role of community-level SES independent of individual-level SES.

METHODS:

The authors of this report examined both individual-level and community-level SES in relation to breast cancer survival in a population-based cohort of women ages 20 to 69 years who were diagnosed with breast cancer in Wisconsin between 1995 and 2003 (N = 5820).

RESULTS:

Compared with college graduates, women who had no education beyond high school were 1.39 times more likely (95% confidence interval [CI], 1.10-1.76) to die from breast cancer. Women who had household incomes <2.5 times the poverty level were 1.46 times more likely (95% CI, 1.10-1.92) to die from breast cancer than women who had household incomes ≥5 times the poverty level. Adjusting the analysis for use of screening mammography, disease stage at diagnosis, and lifestyle factors eliminated the disparity by income, but the disparity by education persisted (hazard ratio [HR], 1.27; 95% CI, 0.99-1.61). In multilevel analyses, low community-level education was associated with increased breast cancer mortality even after adjusting for individual-level SES (HR, 1.57; 95% CI, 1.09-2.27 for ≥20% vs <10% of adults without a high school degree).

CONCLUSIONS:

The current results indicated that screening and early detection explain some of the disparity according to SES, but further research will be needed to understand the additional ways in which individual-level and community-level education are associated with survival. Cancer 2011. © 2010 American Cancer Society.

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