DEPRIVATION AND SURVIVAL FROM BREAST-CANCER

We studied the association between deprivation and survival from breas t cancer in 29 676 women aged 30 and over who were diagnosed during th e period 1980-89 in the area covered by the South Thames Regional Heal th Authority. The measure of deprivation was the Carstairs Index of th e census enumeration district of each woman's residence at diagnosis. We studied the impact of stage at diagnosis, morphology and type of tr eatment on this association, with the relative survival rate and the h azard ratio as measures of outcome. There was a clear gradient in surv ival, with better survival for women from more affluent areas. At all ages, women in the most deprived category had a 35% greater hazard of death than women from the most affluent areas after adjustment for sta ge at diagnosis, morphological type and type of treatment. In younger women (30-64 years), the survival gradient by deprivation category can not be explained by these prognostic factors. In cider women (65-99 ye ars), part of the unadjusted gradient in survival can be explained by differences in the stage of disease: older women in the most deprived category were more often diagnosed with advanced disease. Other factor s, so far unidentified, are responsible for the gradient in breast can cer survival by deprivation category. The potential effect on breast c ancer mortality of eliminating the gradient in survival by deprivation category is substantial (7.4%). In women aged 30-64 years, 10% of all deaths within 5 years might be avoidable, while in older women this f igure is 5.8%.