Stage-specific survival has improved for young breast cancer patients since 2000: but not equally

• Published in: Breast cancer research and treatment 2020-07, Vol.182 (2), p.477-489
• Main Authors: Trewin, Cassia Bree, Johansson, Anna Louise Viktoria, Hjerkind, Kirsti Vik, Strand, Bjørn Heine, Kiserud, Cecilie Essholt, Ursin, Giske
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Cancer patients; Cancer research; Care and treatment; Diagnosis; Educational Status; Epidemiology; Female; Follow-Up Studies; Health care reform; Health Status Disparities; Humans; Income - statistics & numerical data; Life tables; Medicine; Medicine & Public Health; Middle Aged; Mortality; Mortality - trends; National health insurance; Neoplasm Staging; Norway - epidemiology; Oncology; Patient outcomes; Patients; Registries - statistics & numerical data; Social Class; Socioeconomic factors; Survival; Survival Analysis; Universal Health Care
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-020-05698-z

Purpose The stage-specific survival of young breast cancer patients has improved, likely due to diagnostic and treatment advances. We addressed whether survival improvements have reached all socioeconomic groups in a country with universal health care and national treatment guidelines. Methods Using Norwegian registry data, we assessed stage-specific breast cancer survival by education and income level of 7501 patients (2317 localized, 4457 regional, 233 distant and 494 unknown stage) aged 30–48 years at diagnosis during 2000–2015. Using flexible parametric models and national life tables, we compared excess mortality up to 12 years from diagnosis and 5-year relative survival trends, by education and income as measures of socioeconomic status (SES). Results Throughout 2000–2015, regional and distant stage 5-year relative survival improved steadily for patients with high education and high income (high SES), but not for patients with low education and low income (low SES). Regional stage 5-year relative survival improved from 85 to 94% for high SES patients (9% change; 95% confidence interval: 6, 13%), but remained at 84% for low SES patients (0% change; − 12, 12%). Distant stage 5-year relative survival improved from 22 to 58% for high SES patients (36% change; 24, 49%), but remained at 11% for low SES patients (0% change; − 19, 19%). Conclusions Regional and distant stage breast cancer survival has improved markedly for high SES patients, but there has been little survival gain for low SES patients. Socioeconomic status matters for the stage-specific survival of young breast cancer patients, even with universal health care.