Primary and secondary care management of women with early breast cancer from affluent and deprived areas: retrospective review of hospital and general practice records

Objectives To investigate whether poorer survival of breast cancer among de prived women compared with affluent women is related to their NHS care, Design Retrospective review of hospital and general practice case records. Setting Greater Glasgow Health Board area. Subjects Women diagnosed with breast cancer in 1992-3 who lived in die most affluent (deprivation categories 1 and 2) and the most deprived areas (dep rivation categories 6 and 7) of Glasgow (Carstairs and Morris deprivation i ndex). Main outcome measures Breast cancer treatment, time from general practice c onsultation to clinic visit and surgery, and details of hospital admissions and follow up in primary and secondary care. Results The access to care and surgical and oncological treatment of women from affluent and deprived areas were similar, Admissions to hospital for p roblems not related to breast cancer were more common in those living in de prived areas (number admitted once or more: 51 (24%) v 13 (10%), P = 0.001) . Consultation patterns in general practice by the second year after diagno sis showed women in deprived areas consulting more frequently than women in affluent areas (median (interquartile range) number of consultations (5 (2 -10) v 7 (4-13), P = 0.01). Conclusion Women living in affluent areas did not receive better NHS care f or breast cancer than women in deprived areas. However, women from deprived areas seem to have greater comorbidity, and poorer outcomes from breast ca ncer among these women is probably due to factors which result in deprived communities having poorer health outcomes rather than to management of thei r breast cancer.