Levels of socio-economic deprivation affect screening uptake for breast cancer – study shows

There is a lower uptake of breast cancer screening in more deprived areas, and some ethnic groups should also no longer be considered ‘low risk’ of developing the disease, new research has shown.

Researchers from Public Health England (PHE) London and King’s College London concluded that women who live in more deprived areas of London are less likely to attend their first routine breast cancer screening appointment.

The study examined the records of 159,000 women in England aged between 50 and 52 to see whether they attended their first routine breast cancer screening appointment between 2006 and 2009. This proportion attending was largest in the South East London area, with 73 per cent of women living in the most affluent areas attending their screening appointment, compared with 59 per cent in the most deprived.

Lead author Ruth Jack, epidemiologist from PHE London, said: “It's worrying that breast cancer screening uptake is different depending on the deprivation of the area women live in. We need to make sure that things like cost of travel and having time away from work aren’t making it harder for women from more deprived areas to go for screening.

“Some screening areas within London have a more similar uptake across their area. Any initiatives that have improved attendance in women in deprived areas or from particular ethnic groups should be shared across London and the country.”

In a separate study, researchers at the University of Sheffield examined breast cancer rates in the South Asian population in Leicester. Previous studies in the UK have found that incidence of breast cancer is lower in the South Asian population compared to other groups, however, this research points towards a marked change in breast cancer risk in South Asian women over the study period.

Breast cancer incidence data from the National Cancer Registration Service and 2001 census data were used to calculate rates of breast cancer over a 10 year period (2000-2009). Trends in incidence were compared between South Asians and other ethnicities and between socioeconomic groups. Between 2000-2004, South Asian women were found to have a 45 per cent lower rate of breast cancer compared to white women, as found in previous studies.

However, by the 2005-2009 period rates of breast cancer among South Asian women had increased significantly and was eight per cent higher than white women, whose rates had not changed significantly. In South Asians over 65 years, this change was statistically significant, with South Asian women in this group now having a 37 per cent higher risk of breast cancer than white women.

For all ethnicities combined, rates of breast cancer did not change with socioeconomic deprivation in 2000-2004, but in 2005-2009 it increased with socioeconomic deprivation, contrary to national trends.

Study author Matthew Day, Honorary Lecturer in Public Health at the University of Sheffield, said:  “Historically South Asian women, and women in lower socio-economic groups, have been considered at lower risk of developing breast cancer. Based on our study in Leicester, this should no longer be considered the case.
“The exact causes behind this change are not clear cut, they could relate to increases in screening uptake among these groups of women, which have in the past been shown to be lower than in other groups. Or they could be due to changes in lifestyle factors, like having fewer children and having them later in life, increased use of oral contraceptives, and increased smoking and alcohol intake – factors linked to increased breast cancer risk across the board.”

Dr Mick Peake, Clinical Lead at Public Health England’s National Cancer Intelligence Network, said:  “The London study adds weight to an increasing body of evidence showing that patients from deprived areas access cancer screening less often which you would expect to be translated into worse outcomes. We need to look for new ways to make it easier for people from such areas to attend for screening.

“The results of the Leicester study should assist public health services to both plan for, and respond to, the changing risk profile of breast cancer in the population, particularly with regards to Asian women who for a long time have been another group whose attendance rate for screening has been low. At the individual level, if women are concerned about breast cancer, they should speak to their GP.”

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