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Are there socioeconomic gradients in stage and grade of breast cancer at diagnosis? Cross sectional analysis of UK cancer registry data

BMJ 2004; 329 doi: (Published 15 July 2004) Cite this as: BMJ 2004;329:142
  1. Jean Adams (, research fellow1,
  2. Martin White, senior lecturer in public health1,
  3. David Forman, professor of cancer epidemiology2
  1. 1 School of Population and Health Science, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH
  2. 2 University of Leeds, Leeds LS2 9JT
  1. Correspondence to: J Adams


    Socioeconomic gradients in uptake of breast cancer screening in the United Kingdom should, intuitively, lead to socioeconomic gradients in disease progression at diagnosis.1 However, studies have found little evidence of such an effect.25 Although this could be interpreted as evidence that socioeconomic gradients in uptake of screening do not have clinically important consequences, all of the published studies have used data from before (pre-1988) or during the early stages (1988-95) of implementation of the national breast cancer screening programme. We investigated the relation between socioeconomic position and progression of breast cancer at diagnosis by using recent data from the Northern and Yorkshire Cancer Registry and Information Service (NYCRIS), which is estimated to achieve around 93% ascertainment.

    Methods and results

    We assessed progression of breast cancer (ICD-10 C50) as both stage and grade at diagnosis. We defined advanced stage as nodal or metastatic spread and high grade as poorly differentiated, undifferentiated, or anaplastic disease. We used Townsend deprivation scores of enumeration district of residence at registration—from 1991 census data standardised to the Northern and Yorkshire region as a whole—to quantify socioeconomic position. …

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