ArticleEuropean journal of epidemiology2016
How much do tumor stage and treatment explain socioeconomic inequalities in breast cancer survival? Applying causal mediation analysis to population-based data.
Article in European journal of epidemiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Factors Explaining Socio-Economic Inequalities in Cancer Survival: A Systematic Review.Cancer control : journal of the Moffitt Cancer CenterPooled it
- Examining the Role of the Social Vulnerability Index in the Association between Race/Ethnicity and Breast Cancer Outcomes.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2026Article
- Mortality following cancer diagnosis among people with non-affective psychoses: mediation by stage at diagnosis and time to treatment initiation.Social psychiatry and psychiatric epidemiology · 2026Article
- Socioeconomic inequalities in adherence to clinical practice guidelines and breast cancer survival: a multicentre population-based study in Spain.BMJ quality & safety · 2025Article
- Article
- Global, Regional, and National Burden of Male Breast Cancer, 1990-2021: A Systematic Analysis for the Global Burden of Disease Study 2021.Cancer medicine · 2025Article
- Novel multi-omics deconfounding variational autoencoders can obtain meaningful disease subtyping.Briefings in bioinformatics · 2024Article
- Patterns of Evidence-Based Care for the Diagnosis, Staging, and First-line Treatment of Breast Cancer by Race-Ethnicity: A SEER-Medicare Study.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2023Article
- The contribution of prognostic factors to socio-demographic inequalities in breast cancer survival in Victoria, Australia.Cancer medicine · 2023Article
- Dynamic changes in quality of life, psychological status, and body image in women who underwent a mastectomy as compared with breast reconstruction: an 8-year follow up.Breast cancer (Tokyo, Japan) · 2023Article
- Article
- Socio-economic inequalities in cancer survival: how do they translate into Number of Life-Years Lost?British journal of cancer · 2022Article
- Article
- Socioeconomic disparities in head and neck cancer survival in Germany: a causal mediation analysis using population-based cancer registry data.Journal of cancer research and clinical oncology · 2021Article
- Are socio-economic inequalities in breast cancer survival explained by peri-diagnostic factors?BMC cancer · 2021Article
- Stage-specific survival has improved for young breast cancer patients since 2000: but not equally.Breast cancer research and treatment · 2020Article
- Association between socioeconomic factors at diagnosis and survival in breast cancer: A population-based study.Cancer medicine · 2020Article
- Which indicators of early cancer diagnosis from population-based data sources are associated with short-term mortality and survival?Cancer epidemiology · 2018Article
- Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study.BMJ (Clinical research ed.) · 2018Article
- Assessment of spatial variation in breast cancer-specific mortality using Louisiana SEER data.Social science & medicine (1982) · 2017Article
Corrections and comments
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3 authors.
Funding
Abstract
Substantial socioeconomic inequalities in breast cancer survival persist in England, possibly due to more advanced cancer at diagnosis and differential access to treatment. We aim to disentangle the contributions of differential stage at diagnosis and differential treatment to the socioeconomic inequalities in cancer survival. Information on 36,793 women diagnosed with breast cancer during 2000-2007 was routinely collected by an English population-based cancer registry. Deprivation was determined for each patient according to her area of residence at the time of diagnosis. A parametric implementation of the mediation formula using Monte Carlo simulation was used to estimate the proportion of the effect of deprivation on survival mediated by stage and by treatment. One-third (35 % [23-48 %]) of the higher mortality experienced by most deprived patients at 6 months after diagnosis, and one tenth (14 % [-3 to 31 %]) at 5 years, was mediated by adverse stage distribution. We initially found no evidence of mediation via differential surgical treatment. However, sensitivity analyses testing some of our study limitations showed in particular that up to thirty per cent of the higher mortality in most deprived patients could be mediated by differential surgical treatment. This study illustrates the importance of using causal inference methods with routine medical data and the need for testing key assumptions through sensitivity analyses. Our results suggest that, although effort for earlier diagnosis is important, this would reduce the cancer survival inequalities only by a third. Because of data limitations, role of differential surgical treatment may have been under-estimated.
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