Skip to main content

Advertisement

SpringerLink
Log in

Socio-economic factors and breast cancer survival – a population-based cohort study (Sweden)

  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Objective: To assess the influence of socio-economic factors on breast cancer survival in Sweden, a country with population-based mammography screening and a uniform health care system aiming to provide care to all on equal terms.

Methods: All women with a first diagnosis of invasive breast cancer in Sweden in 1993 were identified in the Swedish Cancer Register. Their sociodemographic characteristics were determined by record linkages to the 1970, 1980, 1985 and 1990 Census databases, and a nationwide Fertility Register. Information on tumor characteristics at diagnosis was obtained from five Swedish Regional Cancer Registers. Survival status on 31 December 1998, was assessed through follow-up in the Swedish Cause of Death Register.

Results: Of totally 4645 eligible women diagnosed with breast cancer in 1993, 772 had died from breast cancer through 1998. After adjustment for tumor characteristics and age, risk of death was 37 higher among women of low compared to high socio-economic status (HR high vs. low 0.73; 95 CI: 0.54–0.99). This difference was most pronounced in women less than 50 years at diagnosis.

Conclusions: These results show that socio-economic disparities in breast cancer survival prevail even in this relatively homogenous society, offering outreach mammography and standardised treatment regimens in a tax-funded health care system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. F Faggiano T Partanen M Kogevinas P Boffetta (1997) ArticleTitleSocioeconomic differences in cancer incidence and mortality IARC Sci Publ 138 65–176 Occurrence Handle9353664

    PubMed  Google Scholar 

  2. AJ Loon Particlevan J Brug RA Goldbohm PA Brandt Particlevan den J Burg (1995) ArticleTitleDifferences in cancer incidence and mortality among socio-economic groups Scand J Soc Med 23 110–120 Occurrence Handle7676217

    PubMed  Google Scholar 

  3. D Vagero G Persson (1987) ArticleTitleCancer survival and social class in Sweden J Epidemiol Community Health 41 204–209 Occurrence Handle1:STN:280:BieC2s7is1I%3D Occurrence Handle3443812

    CAS  PubMed  Google Scholar 

  4. O Kravdal (1999) ArticleTitleSocial inequalities in cancer survival Tidsskr Nor Laegeforen 1 IssueID19 1577–1583

    Google Scholar 

  5. A Auvinen S Karjalainen E Pukkala (1995) ArticleTitleSocial class and cancer patient survival in Finland Am J Epidemiol 142 1089–1102 Occurrence Handle1:STN:280:BymD28nos1w%3D Occurrence Handle7485054

    CAS  PubMed  Google Scholar 

  6. S Karjalainen E Pukkala (1990) ArticleTitleSocial class as a prognostic factor in breast cancer survival Cancer 66 819–826 Occurrence Handle1:STN:280:By%2BA2M3ltFM%3D Occurrence Handle2386909

    CAS  PubMed  Google Scholar 

  7. MP Coleman P Babb A Sloggett M Quinn B Stavola ParticleDe (2001) ArticleTitleSocioeconomic inequalities in cancer survival in England and Wales Cancer 91 208–216 Occurrence Handle1:STN:280:DC%2BD38%2FivVGmsA%3D%3D Occurrence Handle11148581

    CAS  PubMed  Google Scholar 

  8. AM Pollock N Vickers (1997) ArticleTitleBreast, lung and colorectal cancer incidence and survival in South Thames Region, 1987–192: the effect of social deprivation J Public Health Med 19 288–294 Occurrence Handle1:STN:280:DyaK1c%2FgslSjsw%3D%3D Occurrence Handle9347452

    CAS  PubMed  Google Scholar 

  9. CT Schrijvers JP Mackenbach JM Lutz MJ Quinn MP Coleman (1995) ArticleTitleDeprivation and survival from breast cancer Br J Cancer 72 738–743 Occurrence Handle1:STN:280:ByqA1MbhvFw%3D Occurrence Handle7669587

    CAS  PubMed  Google Scholar 

  10. CS Thomson DJ Hole CJ Twelves DH Brewster RJ Black (2001) ArticleTitlePrognostic factors in women with breast cancer: distribution by socioeconomic status and effect on differences in survival J Epidemiol Community Health 55 308–315 Occurrence Handle1:STN:280:DC%2BD3M3htVChsg%3D%3D Occurrence Handle11297648

    CAS  PubMed  Google Scholar 

  11. C Boyd JY Zhang-Salomons PA Groome WJ Mackillop (1999) ArticleTitleAssociations between community income and cancer survival in Ontario, Canada, and the United States J Clin Oncol 17 2244–2255 Occurrence Handle1:STN:280:DC%2BD3c%2FjtVSisw%3D%3D Occurrence Handle10561282

    CAS  PubMed  Google Scholar 

  12. WJ Mackillop J Zhang-Salomons PA Groome L Paszat E Holowaty (1997) ArticleTitleSocioeconomic status and cancer survival in Ontario J Clin Oncol 15 1680–1689 Occurrence Handle1:STN:280:ByiA3snmt1Y%3D Occurrence Handle9193369

    CAS  PubMed  Google Scholar 

  13. KM Stavraky JR Skillings LW Stitt F Gwadry-Sridhar (1996) ArticleTitleThe effect of socioeconomic status on the long-term outcome of cancer J Clin Epidemiol 49 1155–1160 Occurrence Handle1:STN:280:BymH38vkvFA%3D Occurrence Handle8826996

    CAS  PubMed  Google Scholar 

  14. N Waxler-Morrison TG Hislop B Mears L Kan (1991) ArticleTitleEffects of social relationships on survival for women with breast cancer: a prospective study Soc Sci Med 33 177–183 Occurrence Handle1:STN:280:By6A287hsVM%3D Occurrence Handle1887281

    CAS  PubMed  Google Scholar 

  15. MT Bassett N Krieger (1986) ArticleTitleSocial class and black-white differences in breast cancer survival Am J Public Health 76 1400–1403 Occurrence Handle1:STN:280:BiiD2cnlsFU%3D Occurrence Handle3777285

    CAS  PubMed  Google Scholar 

  16. DJ Delgado WY Lin M Coffey (1995) ArticleTitleThe role of Hispanic race/ethnicity and poverty in breast cancer survival P R Health Sci J 14 103–116 Occurrence Handle1:STN:280:ByqA2czgvVQ%3D Occurrence Handle7617830

    CAS  PubMed  Google Scholar 

  17. L Franzini AF Williams J Franklin SE Singletary RL Theriault (1997) ArticleTitleEffects of race and socioeconomic status on survival of 1332 black, Hispanic, and white women with breast cancer Ann Surg Oncol 4 111–118 Occurrence Handle1:STN:280:ByiB3sbhsFw%3D Occurrence Handle9084846

    CAS  PubMed  Google Scholar 

  18. NH Gordon JP Crowe DJ Brumberg NA Berger (1992) ArticleTitleSocioeconomic factors and race in breast cancer recurrence and survival Am J Epidemiol 1 IssueID35 609–618

    Google Scholar 

  19. HP Greenwald NL Polissar HH Dayal (1996) ArticleTitleRace, socioeconomic status and survival in three female cancers Ethn Health 1 65–75 Occurrence Handle1:STN:280:DyaK1c%2FltFOgsw%3D%3D Occurrence Handle9395549

    CAS  PubMed  Google Scholar 

  20. A Bonett D Roder A Esterman (1984) ArticleTitleDeterminants of case survival for cancers of the lung, colon, breast and cervix in South Australia Med J Aust 141 705–709 Occurrence Handle1:STN:280:BiqD28%2FlvFM%3D Occurrence Handle6094994

    CAS  PubMed  Google Scholar 

  21. A Nandakumar N Anantha TC Venugopal R Sankaranarayanan K Thimmasetty M Dhar (1995) ArticleTitleSurvival in breast cancer: a population-based study in Bangalore, India Int J Cancer 60 593–596 Occurrence Handle1:STN:280:ByqC28vgt1U%3D Occurrence Handle7860132

    CAS  PubMed  Google Scholar 

  22. MP Coleman B Rachet LM Woods et al. (2004) ArticleTitleTrends and socioeconomic inequalities in cancer survival in England and Wales up to 2001 Br J Cancer 90 1367–1373 Occurrence Handle1:STN:280:DC%2BD2c7mtValtg%3D%3D Occurrence Handle15054456

    CAS  PubMed  Google Scholar 

  23. JL Kelsey PL Horn-Ross (1993) ArticleTitleBreast cancer: magnitude of the problem and descriptive epidemiology Epidemiol Rev 5 7–16

    Google Scholar 

  24. InstitutionalAuthorNameNational Board of Health and Welfare (1996) Cancer incidence in Sweden 1993 The cancer register, Centre for Epidemiology Stockholm, Sweden

    Google Scholar 

  25. CT Schrijvers JW Coebergh LH Heijden Particlevan der JP Mackenbach (1995) ArticleTitleSocioeconomic status and breast cancer survival in the southeastern Netherlands, 1980–1989 Eur J Cancer 31 1660–1664

    Google Scholar 

  26. J Haybittle J Houghton M Baum (1997) ArticleTitleSocial class and weight as prognostic factors in early breast cancer Br J Cancer 75 729–733 Occurrence Handle1:STN:280:ByiC1MrmsF0%3D Occurrence Handle9043032

    CAS  PubMed  Google Scholar 

  27. GK Reeves J Patterson MP Vessey D Yeates L Jones (2000) ArticleTitleHormonal and other factors in relation to survival among breast cancer patients Int J Cancer 89 293–299 Occurrence Handle1:STN:280:DC%2BD3czitFCiug%3D%3D Occurrence Handle10861507

    CAS  PubMed  Google Scholar 

  28. M Kogevinas MG Marmot AJ Fox PO Goldblatt (1991) ArticleTitleSocioeconomic differences in cancer survival J Epidemiol Community Health 45 216–219 Occurrence Handle1:STN:280:By2D1MbgtlU%3D Occurrence Handle1757764

    CAS  PubMed  Google Scholar 

  29. P Boffetta F Merletti R Winkelmann C Magnani AP Cappa B Terracini (1993) ArticleTitleSurvival of breast cancer patients from Piedmont, Italy Cancer Causes Control 4 209–215 Occurrence Handle1:STN:280:ByyA3cros1E%3D Occurrence Handle8318637

    CAS  PubMed  Google Scholar 

  30. S Rosso F Faggiano R Zanetti G Costa (1997) ArticleTitleSocial class and cancer survival in Turin, Italy J Epidemiol Community Health 51 30–34 Occurrence Handle1:STN:280:ByiB1c7kslM%3D Occurrence Handle9135785

    CAS  PubMed  Google Scholar 

  31. www.sos.se/epc/english/cancereng.htm.

  32. JP Garne K Aspegren T Moller (1995) ArticleTitleValidity of breast cancer registration from one hospital into the Swedish National Cancer Registry 1971–1991 Acta Oncol 34 153–156 Occurrence Handle1:STN:280:ByqB3svjt10%3D Occurrence Handle7718251

    CAS  PubMed  Google Scholar 

  33. L Johansson F Finnäs (1983) Fertility of Swedish Women Born 1927–1960 Statistics Sweden Stockholm

    Google Scholar 

  34. InstitutionalAuthorNameNational Board of Health and Welfare (2001) Dödsorsaker 1998 [Causes of death 1998] Centre for Epidemiology, National Board of Health and Welfare Stockholm, Sweden

    Google Scholar 

  35. L Nystrom LG Larsson LE Rutqvist et al. (1995) ArticleTitleDetermination of cause of death among breast cancer cases in the Swedish randomized mammography screening trials. A comparison between official statistics and validation by an endpoint committee Acta Oncol 34 145–152 Occurrence Handle1:STN:280:ByqB3svjt1w%3D Occurrence Handle7718250

    CAS  PubMed  Google Scholar 

  36. P Hermanek LH Sobin (Eds) (1987) TNM Classification of Malignant Tumours International Union Against Cancer Geneva

    Google Scholar 

  37. InstitutionalAuthorNameStatistics Sweden (1982) Swedish Socioeconomic Classification. Reports on Statistical Coordination 1982:4 Örebro Sweden

    Google Scholar 

  38. DR Cox (1972) ArticleTitleRegression models and life tables J R Stat Soc Ser B 34 182–202

    Google Scholar 

  39. DY Lin LJ Wei Z Zing (1990) ArticleTitleChecking the Cox model with cumulative sums of martingale-based residuals Biometrika 80 557–572

    Google Scholar 

  40. StataCorp. Stata Statistical Software (2001). Release 7.0. College Station, TX: Stata Corporation.

  41. InstitutionalAuthorNameSplus (2000) Guide to Statistics Data Analysis Product Division MathSoft Seattle

    Google Scholar 

  42. F Kaffashian S Godward T Davies L Solomon J McCann SW Duffy (2003) ArticleTitleSocioeconomic effects on breast cancer survival: proportion attributable to stage and morphology Br J Cancer 89 1693–1696 Occurrence Handle1:STN:280:DC%2BD3srgs1Gqsw%3D%3D Occurrence Handle14583771

    CAS  PubMed  Google Scholar 

  43. M Lagerlund P Sparen E Thurfjell A Ekbom M Lambe (2000) ArticleTitlePredictors of non-attendance in a population-based mammography screening programme; socio-demographic factors and aspects of health behaviour Eur J Cancer Prev 9 25–33 Occurrence Handle1:STN:280:DC%2BD3c3js1Oltw%3D%3D Occurrence Handle10777007

    CAS  PubMed  Google Scholar 

  44. AG Carnon A Ssemwogerere DW Lamont et al. (1994) ArticleTitleRelation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer BMJ 309 1054–1057 Occurrence Handle1:STN:280:ByqD3sfhs1Y%3D Occurrence Handle7950739

    CAS  PubMed  Google Scholar 

  45. DH Brewster CS Thomson DJ Hole RJ Black PL Stroner CR Gillis (2001) ArticleTitleRelation between socioeconomic status and tumour stage in patients with breast, colorectal, ovarian, and lung cancer: results from four national, population based studies BMJ 322 830–831 Occurrence Handle1:STN:280:DC%2BD3M3jslahtQ%3D%3D Occurrence Handle11290637

    CAS  PubMed  Google Scholar 

  46. H Jonsson L Nystrom S Tornberg P Lenner (2001) ArticleTitleService screening with mammography of women aged 50–69 years in Sweden: effects on mortality from breast cancer J Med Screen 8 152–160 Occurrence Handle1:STN:280:DC%2BD3MrntVKitg%3D%3D Occurrence Handle11678556

    CAS  PubMed  Google Scholar 

  47. H Jonsson S Tornberg L Nystrom P Lenner (2000) ArticleTitleService screening with mammography in Sweden – evaluation of effects of screening on breast cancer mortality in age group 40–49 years Acta Oncol 39 617–623 Occurrence Handle1:STN:280:DC%2BD3M%2Fkt12lsA%3D%3D Occurrence Handle11093370

    CAS  PubMed  Google Scholar 

  48. Tejler G, Einarsson E, Nordenskjöld B, the Southeast Sweden Breast Cancer Group (2003) Breast cancer treatment in nine hospitals in Southeast Sweden 1986–1999. Comparison of outcome. Eur J Cancer 1: (suppl:1).

    Google Scholar 

  49. J Manjer I Andersson G Berglund et al. (2000) ArticleTitleSurvival of women with breast cancer in relation to smoking Eur J Surg 166 852–858 Occurrence Handle10.1080/110241500447227 Occurrence Handle1:STN:280:DC%2BD3MzgtlKiug%3D%3D Occurrence Handle11097150

    Article  CAS  PubMed  Google Scholar 

  50. K Tominaga J Andow Y Koyama et al. (1998) ArticleTitleFamily environment, hobbies and habits as psychosocial predictors of survival for surgically treated patients with breast cancer Jpn J Clin Oncol 28 36–41 Occurrence Handle1:STN:280:DyaK1c7ltFynsg%3D%3D Occurrence Handle9491140

    CAS  PubMed  Google Scholar 

  51. P Wallstrom E Wirfalt L Janzon et al. (2000) ArticleTitleFruit and vegetable consumption in relation to risk factors for cancer: a report from the Malmo Diet and Cancer Study Public Health Nutr 3 263–271 Occurrence Handle1:STN:280:DC%2BD3M%2FpsFWhtw%3D%3D Occurrence Handle10979146

    CAS  PubMed  Google Scholar 

  52. L Lissner SE Johansson J Qvist S Rossner A Wolk (2000) ArticleTitleSocial mapping of the obesity epidemic in Sweden Int J Obes Relat Metab Disord 24 801–805 Occurrence Handle1:STN:280:DC%2BD3czkt1yntQ%3D%3D Occurrence Handle10878690

    CAS  PubMed  Google Scholar 

  53. M Lindstrom PO Ostergren (2001) ArticleTitleIntermittent and daily smokers: two different socioeconomic patterns, and diverging influence of social participation Tob Control 10 258–266 Occurrence Handle1:STN:280:DC%2BD3MvpsF2jsg%3D%3D Occurrence Handle11544391

    CAS  PubMed  Google Scholar 

  54. N Kroman J Wohlfahrt KW Andersen HT Mouridsen T Westergaard M Melbye (1998) ArticleTitleParity, age at first childbirth and the prognosis of primary breast cancer Br J Cancer 78 1529–1533 Occurrence Handle1:STN:280:DyaK1M%2Flt1ejtQ%3D%3D Occurrence Handle9836489

    CAS  PubMed  Google Scholar 

  55. G Pompe Particlevan der MH Antnoni CL Mulder et al. (1994) ArticleTitlePsychoneuroimmunology and the course of breast cancer: an overview. The impact of psychological factors on progression of breast cancer through immune and endocrine mechanisms Psychooncology 3 271–288

    Google Scholar 

  56. E Maunsell J Brisson L Deschenes (1995) ArticleTitleSocial support and survival among women with breast cancer Cancer 76 631–637 Occurrence Handle1:STN:280:BymB38zgvVQ%3D Occurrence Handle8625157

    CAS  PubMed  Google Scholar 

  57. K Ell R Nishimoto L Mediansky J Mantell M Hamovitch (1992) ArticleTitleSocial relations, social support and survival among patients with cancer J Psychosom Res 36 531–541 Occurrence Handle1:STN:280:By2A2cbjsFQ%3D Occurrence Handle1640391

    CAS  PubMed  Google Scholar 

  58. O Gilbar (1996) ArticleTitleThe connection between the psychological condition of breast cancer patients and survival. A follow-up after eight years Gen Hosp Psychiatry 18 266–270 Occurrence Handle1:STN:280:BymH38bhs1Q%3D Occurrence Handle8832261

    CAS  PubMed  Google Scholar 

  59. M Watson JS Haviland S Greer J Davidson JM Bliss (1999) ArticleTitleInfluence of psychological response on survival in breast cancer: a population-based cohort study Lancet 354 1331–1336 Occurrence Handle10.1016/S0140-6736(98)11392-2 Occurrence Handle1:STN:280:DC%2BD3c%2FgtFChug%3D%3D Occurrence Handle10533861

    Article  CAS  PubMed  Google Scholar 

  60. PW Dickman A Auvinen ET Voutilainen T Hakulinen (1998) ArticleTitleMeasuring social class differences in cancer patient survival: is it necessary to control for social class differences in general population mortality? A Finnish population-based study J Epidemiol Community Health 52 727–734 Occurrence Handle1:STN:280:DyaK1MzisVyhtQ%3D%3D Occurrence Handle10396505

    CAS  PubMed  Google Scholar 

  61. HP Greenwald NL Polissar EF Borgatta R McCorkle (1994) ArticleTitleDetecting survival effects of socioeconomic status: problems in the use of aggregate measures J Clin Epidemiol 47 903–909 Occurrence Handle1:STN:280:ByqB2cfjsl0%3D Occurrence Handle7730894

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 281, SE-171 77, Stockholm, Sweden

    Magdalena Lagerlund, Rino Bellocco & Mats Lambe

  2. Department of Oncology, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden

    Per Karlsson

  3. Department of Surgery, County Hospital of Västervik, SE-593 81, Västervik, Sweden

    Göran Tejler

Authors
  1. Magdalena Lagerlund
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rino Bellocco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Per Karlsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Göran Tejler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mats Lambe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Magdalena Lagerlund.

Additional information

Financial support: This study was supported by the Swedish Council for Social Research (grant No. 97-0221), Karolinska Institutet Research Funds and the Swedish Cancer Society.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lagerlund, M., Bellocco, R., Karlsson, P. et al. Socio-economic factors and breast cancer survival – a population-based cohort study (Sweden). Cancer Causes Control 16, 419–430 (2005). https://doi.org/10.1007/s10552-004-6255-7

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-004-6255-7

Keywords

Search

Navigation