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Introduction
Socioeconomic gradients in uptake of breast cancer screening in the United Kingdom should, intuitively, lead to socioeconomic gradients in disease progression at diagnosis. 1 However, studies have found little evidence of such an effect. 2 â[euro]" 5 Although this could be interpreted as evidence that socioeconomic gradients in uptake of screening do not have clinically important consequences, all of the published studies have used data from before (pre-1988) or during the early stages (1988-95) of implementation of the national breast cancer screening programme. We investigated the relation between socioeconomic position and progression of breast cancer at diagnosis by using recent data from the Northern and Yorkshire Cancer Registry and Information Service (NYCRIS), which is estimated to achieve around 93% ascertainment.
Methods and results
We assessed progression of breast cancer (ICD-10 C50) as both stage and grade at diagnosis. We defined advanced stage as nodal or metastatic spread and high grade as poorly differentiated, undifferentiated, or anaplastic disease. We used Townsend deprivation scores of enumeration district of residence at registration-from 1991 census data standardised to the Northern and Yorkshire region as a whole-to quantify socioeconomic position.
All 12 793 women with breast cancer registered with NYCRIS between 1998 and 2000 were eligible for inclusion. Full information was available for 11 512 (90.0%) women on stage of cancer at diagnosis and for 10 388 (81.2%) women on grade of cancer at diagnosis. The table shows the odds ratios for advanced stage or high grade of breast cancer at diagnosis by fifths of Townsend score.
Advanced stage at diagnosis * | High grade at diagnosis [dagger] | ||||
Fifth of THS | THS range | No (%) | Odds ratio (95% CI) | No (%) | Odds ratio (95% CI) |
1(most affluent) | -8.89 to -3.32 |