title: Impact of a positive family history on diagnosis, management, and survival of breast cancer: different effects across socio-economic groups.
abstract: BACKGROUND
  This study aims to investigate whether increased awareness of breast cancer, due to a positive family history (FH), reduces diagnostic, therapeutic, and survival differences between women of low versus high socio-economic status (SES).
  
  
  METHODS
  All breast cancer patients registered between 1990 and 2005 at the population-based Geneva Cancer Registry were included. With multivariate logistic and Cox regression analysis, we estimated the impact of SES and FH on method of detection, treatment, and mortality from breast cancer.
  
  
  RESULTS
  SES discrepancies in method of detection and suboptimal treatment, as seen among women without a FH, disappeared in the presence of a positive FH. SES differences in stage and survival remained regardless of the presence of a positive FH. Overall, positive FH was associated with better survival. This effect was the strongest in women of high SES (age-adjusted Hazard Ratio [HR(ageadj)] 0.54 [0.3-1.0]) but less pronounced in women of middle (0.77 [0.6-1.0]), and absent in women of low SES (0.80 [0.5-1.2]).
  
  
  CONCLUSIONS
  A positive FH of breast cancer may reduce SES differences in access to screening and optimal treatment. However, even with better access to early detection and optimal treatment, women of low SES have higher risks of death from their disease than those of high SES.
authors.affiliation: Geneva Cancer Registry, Geneva University, Geneva, Switzerland. ephhmv@nus.edu.sg
authors.forename: H M
authors.initials: HM
authors.lastname: Verkooijen
authors.forename: E
authors.initials: E
authors.lastname: Rapiti
authors.forename: G
authors.initials: G
authors.lastname: Fioretta
authors.forename: V
authors.initials: V
authors.lastname: Vinh-Hung
authors.forename: J
authors.initials: J
authors.lastname: Keller
authors.forename: S
authors.initials: S
authors.lastname: Benhamou
authors.forename: G
authors.initials: G
authors.lastname: Vlastos
authors.forename: P O
authors.initials: PO
authors.lastname: Chappuis
authors.forename: C
authors.initials: C
authors.lastname: Bouchardy
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics* / Q000628:therapy; D003131:Combined Modality Therapy; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D020022:Genetic Predisposition to Disease; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D011878:Radiotherapy; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors
chemical_list: D000970:Antineoplastic Agents