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02-17-2006, 04:54 PM

I have been asking myself if I over reacted to the article above. On reflect maybe, but it could maybe have been clearer.

It is clearly a complex issue, and there can be very good individual reason for the choice.

However the issue has also been raised as to whether there is a link between economic circumstances and masectomy as an option. I read this link a while ago.

Does deprivation affect breast cancer management?

http://www.nature.com/bjc/journal/v9.../6602390a.html

ABSTRACT

We evaluated whether social deprivation affected decision-making for breast cancer surgery. Of 3419 patients, 53.6% had mastectomy and this was predicted by deprivation, age, tumour size and hospital, all of which retained significance on multivariate analysis, except deprivation. Pathological characteristics and surgical decision-making determined choice of operation not deprivation.

Keywords: social deprivation; breast carcinoma; surgical decision-making

Awareness of health inequalities between rich and poor has never been greater. The recent publication of health and life expectancy data in Scotland has shown that the gap between rich and poor in Glasgow persists (Clark et al, 2004). These inequalities are also seen in women with breast cancer. Survival differences between women from affluent areas and women from deprived areas are around 6% in England and Wales (Coleman et al, 2004) and 10% in Scotland (Thomson et al, 2001). Part of this difference is explained by more oestrogen receptor (ER) negative tumours in deprived women, but no other pathological differences have been observed (Thomson et al, 2001). Several other studies have looked at other pathological criteria as the reason for the persistent survival differences and they have all failed to demonstrate an association (Carnon et al, 1994; Macleod et al, 2000a; Brewster et al, 2001). Access to health services does not appear to be a factor; in fact, deprived women appear to use primary care resources more often than the more affluent (Macleod et al, 2000b). Despite this, the question remains whether deprived women are treated differently in secondary care.

Trials have shown no survival advantage from mastectomy over breast conservation surgery for tumours up to 5 cm (Fisher et al, 2002). The contraindications to conservation are well documented: multifocal tumours; 1st or 2nd trimester of pregnancy; history of previous irradiation to the affected breast; or a large tumour in a small breast that would result in an unacceptable cosmetic result.

We have analysed data from the Glasgow Breast Cancer Audit to measure the mastectomy rate. We hypothesised that if the mastectomy rate was higher than expected, this might be a reflection of high levels of deprivation in Glasgow (McLoone, 2004). Additionally, if surgeons were influencing women in choice of surgical management, were they actively suggesting conservation for affluent women?

02-17-2006, 04:54 PM	#16
Unregistered Guest Posts: n/a	Does deprivation affect breast cancer management? I have been asking myself if I over reacted to the article above. On reflect maybe, but it could maybe have been clearer. It is clearly a complex issue, and there can be very good individual reason for the choice. However the issue has also been raised as to whether there is a link between economic circumstances and masectomy as an option. I read this link a while ago. Does deprivation affect breast cancer management? http://www.nature.com/bjc/journal/v9.../6602390a.html ABSTRACT We evaluated whether social deprivation affected decision-making for breast cancer surgery. Of 3419 patients, 53.6% had mastectomy and this was predicted by deprivation, age, tumour size and hospital, all of which retained significance on multivariate analysis, except deprivation. Pathological characteristics and surgical decision-making determined choice of operation not deprivation. Keywords: social deprivation; breast carcinoma; surgical decision-making Awareness of health inequalities between rich and poor has never been greater. The recent publication of health and life expectancy data in Scotland has shown that the gap between rich and poor in Glasgow persists (Clark et al, 2004). These inequalities are also seen in women with breast cancer. Survival differences between women from affluent areas and women from deprived areas are around 6% in England and Wales (Coleman et al, 2004) and 10% in Scotland (Thomson et al, 2001). Part of this difference is explained by more oestrogen receptor (ER) negative tumours in deprived women, but no other pathological differences have been observed (Thomson et al, 2001). Several other studies have looked at other pathological criteria as the reason for the persistent survival differences and they have all failed to demonstrate an association (Carnon et al, 1994; Macleod et al, 2000a; Brewster et al, 2001). Access to health services does not appear to be a factor; in fact, deprived women appear to use primary care resources more often than the more affluent (Macleod et al, 2000b). Despite this, the question remains whether deprived women are treated differently in secondary care. Trials have shown no survival advantage from mastectomy over breast conservation surgery for tumours up to 5 cm (Fisher et al, 2002). The contraindications to conservation are well documented: multifocal tumours; 1st or 2nd trimester of pregnancy; history of previous irradiation to the affected breast; or a large tumour in a small breast that would result in an unacceptable cosmetic result. We have analysed data from the Glasgow Breast Cancer Audit to measure the mastectomy rate. We hypothesised that if the mastectomy rate was higher than expected, this might be a reflection of high levels of deprivation in Glasgow (McLoone, 2004). Additionally, if surgeons were influencing women in choice of surgical management, were they actively suggesting conservation for affluent women?