Management of women with early breast cancerBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7273.1408/a (Published 02 December 2000) Cite this as: BMJ 2000;321:1408
Affluence seems to affect management of breast cancer
- Janine Bell, senior researcher,
- David Robinson, consultant statistician,
- Henrik Møller, director of research
- Thames Cancer Registry, King's College London, London SE1 3QD
- Breast Test Wales, 18 Cathedral Road, Cardiff CF1 9LJ
- St Bartholomew's Hospital, London EC1A 7BE
- Department of General Practice, University of Glasgow, Glasgow G12 0RR
- CRC Department of Medical Oncology, Beatson Oncology Centre, Western Infirmary, Glasgow G11 6NT
- Department of Surgery, University of Glasgow, Western Infirmary, Glasgow G11 6NT
- West of Scotland Cancer Surveillance Unit, Department of Public Health, University of Glasgow, Glasgow G12 8RZ
EDITOR—Macleod et al in their article present a wealth of data on the management of women with early breast cancer from affluent and deprived areas in Glasgow.1 It would have been informative to examine also a wider range of indicators of quality of care, such as those identified by the Clinical Outcomes Group2 and the British Association of Surgical Oncology,3 including access to specialist teams dealing with more than 100 new cases per year, access to diagnostic testing by triple assessment on the same day, and participation in clinical trials.
The lower rates of axillary sampling found in the deprived group may not be, as Macleod et al impute, solely an artefact due to unusual practice in a single hospital. In our work on monitoring the quality of care for breast cancer in North Thames health region,4 we have found that surgeons use the terms “sampling” and “clearance” rather loosely when recording surgical procedures in the axilla. It is more informative to examine the number of nodes excised—poor practice being excision of too few nodes—to decide on the management of the patient. The comparison of the number of nodes sampled avoids possible bias due to association between hospital terminology and socioeconomic status of the patient.
Although the median wait from referral by the general practitioner to first visit to the clinic was only one day longer for deprived women, there was a distributional shift. Among deprived women, the 25% who waited longest waited 20 days or more. The corresponding figure in the affluent group was only 13 days. Like the one day difference in median waiting time, a one …