Breast cancer stage at diagnosis and area-based socioeconomic status: a multicenter 10-year retrospective clinical epidemiological study in China
Although socioeconomic status (SES) has been focused on as a key determinant of cancer stage at diagosis in western countries, there has been no systemic study on the relationship of SES and breast cancer stage at diagnosis in China.
The medical charts of 4,211 eligible breast cancer patients from 7 areas across China who were diagnosed between 1999 and 2008 were reviewed. Four area-based socioeconomic indicators were used to calculate area-based SES by cluster analysis. The associations between area-based SES and stage at diagnosis were analyzed by trend chi-square tests. Binary logistic regression was performed to estimate odds ratios for individual demographic characteristics' effects on cancer stages, stratified by area-based SES.
The individual demographic and pathologic characteristics of breast cancer cases were significantly different among the seven areas studied. More breast cancer cases in low SES areas (25.5%) were diagnosed later (stages III & IV) than those in high (20.4%) or highest (14.8%) SES areas (χ 2 for trend = 80.79, P < 0.001). When area-based SES is controlled for, in high SES areas, cases with less education were more likely to be diagnosed at later stages compared with more educated cases. In low SES areas, working women appeared to be diagnosed at earlier breast cancer stages than were homemakers (OR: 0.18-0.26).
In China, women in low SES areas are more likely to be diagnosed at later breast cancer stages than those in high SES areas.
- IARC: Cancer Epidemiology Database, GLOBOCAN. [http://www-dep.iarc.fr] 2008.
- Horner MJ, Ries LAG, Krapcho M, et al.: SEER Cancer Statistics Review. [http://seer.cancer.gov/csr/1975_2006/] National Cancer Institute. Bethesda, MD; 2006.
- Parkin DM, Whelan SI, Ferlay J, Raymond L, Young J: Cancer Incidence in Five Continents. Lyon: IARC Scientific Publications; 1997.
- Parkin DM, Whelan SI, Ferlay J, Teppo L, Thomas DB: Cancer Incidence in Five Continents. Lyon: IARC Scientific Publications; 2002.
- Bray F, McCarron P, Parkin DM: The changing global patterns of female breast cancer incidence and mortality. Breast Cancer Res 2004, 6:229–239. CrossRef
- Curado MP, Edwards B, Shin HR, Storm H, Ferlay J, Heanue M, Boyle P: Cancer Incidence in Five Continents. Lyon: IARC Scientific Publications; 2007.
- IARC: Cancer Epidemiology Database, GLOBOCAN. [http://www-dep.iarc.fr/] 2002.
- Tan SM, Evans AJ, Lam TP, Cheung KL: How relevant is breast cancer screening in the Asia/Pacific region? The Breast 2007, 16:113–119. CrossRef
- Sadler GR, Wang K, Wang M, Ko CM: Chinese women: behaviors and attitudes towards breast cancer education and screening. Women Health Issues 2000,10(1):20–26. CrossRef
- Breen N, Wagener DK, Brown ML, Davis WW, Ballard-Barbash R: Progress in cancer screening over a decade: Results of cancer screening from the 1987, 1992, and 1998. National Health Interview Surveys 2001,93(22):1704–1713.
- Diez Roux AV: Investigating neighborhood and area effects on health. American Journal of Public Health 2001,91(11):1783–1789. CrossRef
- Kawachi I, Berkman LF: Neighborhoods and Health. Oxford: Oxford University Press; 2003. CrossRef
- Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV: Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project. American Journal of Public Health 2005,95(2):312–323. CrossRef
- Singh G, Miller BA, Hankey BF, Edwards BK: NCI Cancer Surveillance Monograph Series. Bethesda, MD: National Cancer Institute; 2003.
- Imlach Gunasekara F, Carter KN, Liu I, Richardson K, Blakely T: The relationship between income and health using longitudinal data from New Zealand. Journal of Epidemiol and Community Health 2011, in press. [Epub ahead of print]
- Shepherd CC, Li J, Zubrick SR: Socioeconomic disparities in physical health among Aboriginal and Torres Strait Islander children in Western Australia. Ethn Health 2012, in press. [Epub ahead of print]
- Audureau E, Rican S, Coste J: Worsening trends and increasing disparities in health-related quality of life: evidence from two French population-based cross-sectional surveys, 1995–2003. Qual Life Res 2012, in press. [Epub ahead of print]
- Yu XQ: Socioeconomic disparities in breast cancer survival: relation to stage at diagnosis, treatment and race. BMC Cancer 2009, 9:364. CrossRef
- Barry J, Breen N: The importance of place of residence in predicting late- stage diagnosis of breast or cervical cancer. Health & Place 2005, 11:15–29. CrossRef
- Merkin SS, Stevenson L, Powe N: Geographic socioeconomic status, race, and advanced-stage breast cancer in New York City. American Journal of Public Health 2002, 92:64–70. CrossRef
- Schwartz KL, Crossley-May H, Vigneau FD, Brown K, Banerjee M: Race, socioeconomic status and stage at diagnosis for five common malignancies. Cancer Causes & Control 2003, 14:761–766. CrossRef
- MacKinnon JA, Duncan RC, Huang Y, Lee DJ, Fleming LE, Voti L, Rudolph M, Wilkinson JD: Detecting an association between socioeconomic status and late stage breast cancer using spatial analysis and area-based measures. Cancer Epidemiology Biomarkers & Prevention 2007, 16:756–762. CrossRef
- Roche LM, Skinner R, Weinstein RB: Use of a geographic information system to identify and characterize areas with high proportions of distant stage breast cancer. Journal of Public Health Management & Practice 2002, 8:26–32.
- Sheehan TJ, DeChello LM: A space-time analysis of the proportion of late stage breast cancer in Massachusetts, 1988–1997. International Journal of Health Geographics 2005, 4:15. CrossRef
- Xu ZY, Li ST: Analysis on the trend of regional income disparity in China. Economic Research Journal 2006, 7:106–116. in Chinese
- Li J, Zhang BN, Fan JH, et al.: A Nation-wide Multicenter 10-year (1999–2008) Retrospective Clinical Epidemiological Study of Breast Cancer in China. BMC Cancer 2011,11(1):364. CrossRef
- Fleming ID, Cooper JS, Henson DE, et al.: AJCC Cancer Staging Manual. 5th edition. Philadelphia: Lippincott Raven; 1997.
- Greene F, Page D, Fleming I, Fritz A, Balch C, Haller D, Morrow M: AJCC Cancer Staging Manual. 6th edition. Philadelphia: Springer; 2002.
- Diez Roux AV: The study of group-level factors in epidemiology: rethinking variables, study designs, and analytical approaches. Epidemiologia & Prevenzione 2004, 26:104–111. CrossRef
- Pickett KE, Pearl M: Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. Journal of Epidemiol and Community Health 2001,55(2):111–122. CrossRef
- US Census Bureau: US Department of Commerce Economics and Statistics Administration. [http://www2.census.gov/census_2000/datasets/Summary_File_3/New_Jersey/] Washington, DC; 2005.
- Liu L, Ding H, Wang LY, et al.: Analysis on the General Survey Result of Gynecological Diseases in Beijing Area from 2000 to 2005. Chinese General Practice 2006, 15:1275–1276. in Chinese
- Wu QL, Zeng FL, Zeng XQ, Li Ping , Su HM: The analysis of breast cancer screening in Guangzhou from 1994 to2003. Chinese Primary Health Care 2004,18(10):52–54.
- Henry KA, Sherman R, Roche LM: Colorectal cancer stage at diagnosis and area socioeconomic characteristics in NewJersey. Health &Place 2009, 15:505–513. CrossRef
- Halpern MT, Bian J, Ward EM, Schrag NM, Chen AY: Insurance status and stage of cancer at diagnosis among women with breast cancer. Cancer 2007, 110:403–411. CrossRef
- Matthews BA, Anderson RC, Nattinger AB: Colorectal cancer screening behavior and health insurance status (United States). Cancer Causes & Control 2005, 16:735–742. CrossRef
- WHO: Global status report on alcohol and health. [http://www.who.int/substance_abuse/publications] 2011.
- James TM, Greiner KA, Ellerbeck EF, Feng C, Ahluwalia JS: Disparities in colorectal cancer screening: a guideline-based analysis of adherence. Ethnicity & Disease 2006, 16:228–233.
- Huang Y, Zhou K, Li H, et al.: Screening among women from different socio-economic regions in southwest China: A cross-sectional study. Asian Pacific J Cancer Prev 2011, 12:203–209.
- Damiani G, Federico B, Basso D, Ronconi A, Bianchi CB, Anzellotti GM, Nasi G, Sassi F, Ricciardi W: Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study. BMC Public Health 2012, in press. [Epub ahead of print]
- Baquet CR, Commiskey P: Socioeconomic factors and breast carcinoma in multicultural women. Cancer 2000, 88:1256–1264. CrossRef
- Singh GK, Miller BA, Hankey BF, Edwards BK: Area socioeconomic variation in US cancer incidence, mortality, stage, treatment, and survival 1975–1999. Bethesda, MD, National Cancer Institute; 2003. NCI Cancer Surveillance Monograph Series, Number 4
- Launay L, Dejardin O, Pornet C, Morlais F, Guittet L, Launoy G, Bouvier V: Influence of socioeconomic environment on survival in patients diagnosed with esophageal cancer: a population-based study. Dis Esophagus 2012, in press. [Epub ahead of print]
- Joslyn SA: Racial differences in treatment and survival from early-stage breast carcinoma. Cancer 2002,95(8):1759–1766. CrossRef
- Smedley B, Stith A, Nelson A: Unequal treatment: confronting racial and ethnic disparities in health care, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Institute of Medicine, Washington, DC: National Academy Press; 2002.
- Shyyan R, Masood S, Badwe RA, Errico KM, Liberman L, Ozmen V, Stalsberg H, Vargas H, Vass L: Global Summit Diagnosis and Pathology Panel: Breast cancer in limited-resource countries: diagnosis and pathology. Breast Journal 2006,12(Suppl 1):S27–37. CrossRef
- Yin D, Morris C, Allen M, Cress R, Bates J, Liu L: Does socioeconomic disparity in cancer incidence vary across racial/ethnic groups? Cancer Causes & Control 2010,21(10):1721–30. CrossRef
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2407/12/122/prepub
- Breast cancer stage at diagnosis and area-based socioeconomic status: a multicenter 10-year retrospective clinical epidemiological study in China
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
- Online Date
- March 2012
- Online ISSN
- BioMed Central
- Additional Links
- Breast cancer
- Stage at diagnosis
- Area-based socioeconomic status
- Retrospective study
- Industry Sectors
- Author Affiliations
- 1. Department of Epidemiology, West China School of Public Health, Sichuan University, 16 Ren Min Nan Lu, Chengdu, Sichuan, 610041, China
- 2. Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing, 100021, China
- 3. Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing, 100021, China
- 4. Center of Breast Disease, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing, 100021, China
- 5. Department of Breast Surgery, Liaoning Cancer Hospital, 44 Xiaoyanhe Road, Dadong District, Shenyang, 110042, China
- 6. Department of Breast Surgery, Zhejiang Cancer Hospital, 38 Banshanqiao Guanji Road, Hangzhou, 310022, China
- 7. Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East, Gungzhou, 510060, China
- 8. Department of Breast-thyroid Surgery, Xiangya Sencod Hospital, Central South University, 139 Renminzhonglu, Changsha, 410011, China
- 9. Department of Breast Surgery, the Second People’s Hospital of Sichuan Province, Chengdu, 610041, China
- 10. Department of Oncosurgery, the First Affiliated Hospital of Medical College, Xi’an Jiao Tong University, 277 Yanta West Road, Xi’an, 710061, China