Socioeconomic status and breast cancer survival in Pakistani women
Aziz, Z.; Sana, S.; Akram, M.; Saeed, A.
Jpma. Journal of the Pakistan Medical Association 54(9): 448-453
2004
ISSN/ISBN: 0030-9982 PMID: 15518365 Document Number: 237330
No data is available from Developing Countries correlating socioeconomic status (SES) with survival in female breast cancer patients. This study was carried out to test the hypotheses whether SES is an independent determinant for disease stage, access to minimal expected treatment (MET) and survival. 286 patients diagnosed with breast cancer, at the Department of Oncology at Jinnah Hospital in Lahore, Pakistan, were recruited between April 1996 and May 1998. Patients were divided into 3 groups according to their SES. Prognostic factors analysed were age, tumour size, nodal status, stage at presentation, oestrogen receptor status, time elapsed before diagnosis and access to MET. Disease free survival (DFS) and overall survival (OS) were determined according to the SES of the patients. Patients were categorized into high (21%), middle (44%) and low (35%) socioeconomic groups. Mean age of all patients was 46 years, in patients from lower SES mean age was 43 years compared to 50 years in high SES. Mean time elapsed before diagnosis for women from high-income group was 4.3 months vs. 10.6 months in low-income group. Early breast cancer was more common in affluent strata at 70% vs. 41% in the lower strata. 89% of patients received MET from the affluent group compared to only 43% patients in the lower strata. Literacy rate of patients from high SES was 73.7% compared to 15% in the low SES. Five year DFS and OS were 79% and 86%, respectively for the high income group, 48% and 68%, respectively for the middle income group and 31% and 49%, respectively for the lower strata. Results were statistically significant at P=0.0001 and P<0.0001. There was a strong association between low SES and advanced diseases, delay in diagnosis, limited access to MET and inferior DFS and OS. It is suggested that the outcome of these patients may be improved by proper education and availability of better health care facilities.