Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care

// Francesca Di Salvo 1 , Nicola Caranci 2 , Teresa Spadea 3 , Nicolas Zengarini 3 , Pamela Minicozzi 1 , Hade Amash 1 , Mario Fusco 4 , Fabrizio Stracci 5 , Fabio Falcini 6 , Claudia Cirilli 7 , Giuseppina Candela 8 , Rosanna Cusimano 9 , Rosario Tumino 10 and Milena Sant 1 for the Socioeconomic Inequalities and Oncological Outcomes Italian Working Group * 1 Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy 2 Agenzia Sanitaria e Sociale Regione Emilia Romagna, Bologna, Italy 3 Servizio Sovrazonale di Epidemiologia ASL Torino 3, Grugliasco, Italy 4 Naples Cancer Registry, ASL Napoli 3 Sud, Brusciano, Italy 5 Umbria Cancer Registry, Public Health Department, University of Perugia, Perugia, Italy 6 Romagna Cancer Registry, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy 7 Modena Cancer Registry, Public Health Department AUSL Modena, Modena, Italy 8 Trapani Cancer Registry, Health Prevention Department ASL 9 Trapani, Trapani, Italy 9 Palermo Cancer Registry, Health Science Department University of Palermo, Palermo, Italy 10 Ragusa Cancer Registry, Health Prevention Department ASP Ragusa, Ragusa, Italy * The Socioeconomic Inequalities and Oncological Outcomes Italian Working Group: Teresa Spadea, Nicolas Zengarini and Paolo Carna (Servizio Sovrazonale di Epidemiologia ASL TO3, Grugliasco, Turin); Giuseppe Costa (University of Turin); Milena Sant, Pamela Minicozzi, Francesca Di Salvo, Paolo Baili and Hade Amash (IRCCS Istituto Nazionale dei Tumori Foundation, Milan); Nicola Caranci (Agenzia Sanitaria e Sociale, Regione Emilia-Romagna, Bologna); Adriano Giacomin (Biella Cancer Registry); Alessandro Barchielli and Gianfranco Manneschi (Toscana Cancer Registry), Claudia Cirilli (Modena Cancer Registry); Fabio Falcini, Rosa Vattiato and Alessandra Ravaioli (Romagna Cancer Registry); Lucia Mangone, Paolo Giorgi Rossi, Enza Di Felice and Massimo Vicentini (Reggio Emilia Cancer Registry); Fabio Pannozzo and Francesca Calabretta (Latina Cancer Registry); Fabrizio Stracci, Fortunato Bianconi and Valerio Brunori (Umbria Cancer Registry); Mario Fusco and Valerio Ciullo (Napoli Cancer Registry); Rosaria Cesaraccio (Sassari Cancer Registry); Rosanna Cusimano, Maurizio Zarcone (Palermo Cancer Registry); Rosario Tumino and Carmela Nicita (Ragusa Cancer Registry); Giuseppina Candela and Tiziana Scuderi (Trapani Cancer Registry); Roberto Lillini (Bicocca University, Milan); Marina Vercelli (University of Genova) Correspondence to: Francesca Di Salvo, email: Francesca.disalvo@istitutotumori.mi.it Keywords: deprivation index, census tract, sentinel lymph node biopsy, breast-conserving surgery, cancer registry Received: December 27, 2016      Accepted: April 26, 2017      Published: July 22, 2017 ABSTRACT Background: Socioeconomic factors influence access to cancer care and survival. This study investigated the role of socioeconomic status on the risk of breast cancer recurrence and on the delivery of appropriate cancer care (sentinel lymph node biopsy and breast-conserving surgery plus radiotherapy), by patients’ age and hormone receptor status. Methods: 3,462 breast cancer cases diagnosed in 2003-2005 were selected from 7 Italian cancer registries and assigned to a socioeconomic tertile on the basis of the deprivation index of their census tract. Multivariable models were applied to assess the delivery of sentinel lymph node biopsy and of breast-conserving surgery plus radiotherapy within socioeconomic tertiles. Results: In the 1,893 women younger than 65 years, the 5-year risk of recurrence was higher in the most deprived group than in the least deprived, but this difference was not significant (16.4% vs. 12.9%, log-rank p=0.08); no difference was seen in women ≥65 years. Among the 2,024 women with hormone receptor-positive cancer, the 5-year risk was significantly higher in the most deprived group than in the least deprived one (13.0% vs. 8.9%, p=0.04); no difference was seen in cases of hormone receptor-negative cancer. The most deprived women were less likely than the least deprived women to receive sentinel lymph node biopsy (adjusted odds ratio (ORa), 0.69; 95% CI, 0.56-0.86) and to undergo breast-conserving surgery plus radiotherapy (ORa=0.66; 95% CI, 0.51-0.86). Conclusions: Socioeconomic inequalities affect the risk of recurrence, among patients with hormone receptor-positive cancer, and the opportunity to receive standard care.