Worsened oncologic outcomes for women of lower socio-economic status (SES) treated for locally advanced breast cancer (LABC) in Pakistan

Abstract 

Two hundred and thirty-seven women, undergoing multimodality treatment for locally advanced breast cancer (LABC), were retrospectively analyzed for age, menopausal status, socio-economic status (SES), tumor size, nodal involvement, tumor grade, estrogen and progesterone receptor (ER, PR) status and tumor stage. Primary purpose was to assess outcomes of these patients treated in a low-income country as defined by the World Bank and using limited-level treatment resources as defined by Breast Health Global Initiative (BHGI) guidelines. Secondary objectives included correlation of predictive and prognostic features with event-free survival (EFS) and overall survival (OS) at 5years.

Predictors of decreased EFS or OS included lower SES [P=0.05 (95%CI 0.34–1.0) and P=0.1 (CI 0.29–1.14)], larger tumor size [P=0.01 (95%CI 1.06–1.59) and P=0.3 (CI 0.86–1.50)] and positive lymph node status [P=0.04 (95% CI 1.0–1.55) and P<0.0001 (CI 1.37–2.64).

In women diagnosed with LABC in Pakistan, patients with lower SES had larger, more aggressive tumors with worsened survival outcomes. Optimal breast cancer care warrants consideration for health care policies that address access to diagnostic and treatment services for financially disadvantaged women.

Keywords: Breast cancer, Developing countries, Socio-economic status, Breast Health Global Initiative Guidelines, Combined modality therapy