Driving, glaucoma, and the law

Abstract

Public health implications* Women from socioeconomically deprived areas have significantly poorer survival from breast cancer than women from affluent areas * In this population based study we investigated the relation between socioeconomic deprivation and the prognostic factors tumour size, axillary lymph node status, histological grade, and oestrogen receptor concentration * Socioeconomic deprivation was not significantly related to tumour stage or biology * Other possible explanations for survival differences, such as differences in breast cancer treatment or in host response, should be investigated * If the reasons for socioeconomic differences in survival could be identified and eliminated a greater number of lives could be saved than that expected from the national breast screening programme prognostic factors we examined cannot explain the differences in survival, other possibilities must be considered.Other biological prognostic factors might differ.Women from deprived areas might be less likely to receive, or to accept, optimal treatment for breast cancer.For example, they might be more likely to withdraw from prolonged chemotherapy regimens.Altematively, women from deprived areas might have reduced ability to slow down the distant spread of breast cancer because of a differential immune response.This could be due to many possible causes, such as diet, smoking, intercurrent disease, or environ- mental factors.These alternative explanations should be investi- gated since the potential benefit in reducing the inequality in survival between deprivation categories is great.For example, it could result in a greater number of lives saved than that expected from the national breast screening programme.Of the sample of 7537 women from the West of Scotland in whom survival was first studied, there were 1344 deaths within five years among those aged between 50 and 64.Assuming a 25% reduction in mortality from breast cancer, as expected from the national breast screening pro- gramme,22 336 of those women could be expected to survive.Theoretically, if the survival gradient by deprivation category could be eliminated so that all women had the five year survival rate of the most affluent group, 475 more women in the West of Scotland could be expected to survive for five years.This would also benefit women outside the age group currently invited for screening.Socioeconomic differ- ences in survival from breast cancer therefore have important implications for public health.