title: Changes over time in socioeconomic inequalities in breast and rectal cancer survival in England and Wales during a 32-year period (1973-2004): the potential role of health care.
abstract: BACKGROUND
  Socioeconomic inequalities in cancer survival are well documented but they vary for different cancers and over time. Reasons for these differences are poorly understood.
  
  
  METHODS
  For England and Wales, we examined trends in socioeconomic survival inequalities for breast cancer in women and rectal cancer in men during the 32-year period 1973-2004. We used a theoretical framework based on Victora's 'inverse equity' law, under which survival inequalities could change with the advent of successive new treatments, of varying effectiveness, which are disseminated with different speed among patients of different socioeconomic groups. We estimated 5-year relative survival for patients of different deprivation quintiles and examined trends in survival inequalities in light of major treatment innovations.
  
  
  RESULTS
  Inequalities in breast cancer survival (921,611 cases) narrowed steadily during the study (from -10% to -6%). In contrast, inequalities in rectal cancer survival (187,104 cases) widened overall (form -5% to -11%) with fluctuating periods of narrowing inequality.
  
  
  CONCLUSIONS
  Trends in socioeconomic differences in tumour or patient factors are unlikely explanations of observed changes over time in survival inequalities. The sequential introduction into clinical practice of new treatments of progressively smaller incremental benefit may partly explain the reduction in inequality in breast cancer survival.
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge. Electronic address: gl290@medschl.cam.ac.uk.
authors.forename: G
authors.initials: G
authors.lastname: Lyratzopoulos
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge.
authors.forename: J M
authors.initials: JM
authors.lastname: Barbiere
authors.affiliation: Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, London.
authors.forename: B
authors.initials: B
authors.lastname: Rachet
authors.affiliation: The Clinical Trials Group, Royal Free and University College London Medical School, Centre for Clinical Science and Technology, London.
authors.forename: M
authors.initials: M
authors.lastname: Baum
authors.affiliation: Department of Colorectal Surgery, Queen Alexandra Hospital, Cosham, Portsmouth, UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Thompson
authors.affiliation: Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, London.
authors.forename: M P
authors.initials: MP
authors.lastname: Coleman
mesh_terms: D001943:Breast Neoplasms / Q000191:economics* / Q000401:mortality*; D003695:Delivery of Health Care; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D012004:Rectal Neoplasms / Q000191:economics* / Q000401:mortality*; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014852:Wales