title: Small but significant socioeconomic inequalities in axillary staging and treatment of breast cancer in the Netherlands.
abstract: BACKGROUND
  The use of sentinel node biopsy (SNB), lymph node dissection, breast-conserving surgery, radiotherapy, chemotherapy and hormonal treatment for breast cancer was evaluated in relation to socioeconomic status (SES) in the Netherlands, where access to care was assumed to be equal.
  
  
  METHODS
  Female breast cancer patients diagnosed between 1994 and 2008 were selected from the nationwide population-based Netherlands Cancer Registry (N=176 505). Socioeconomic status was assessed based on income, employment and education at postal code level. Multivariable models included age, year of diagnosis and stage.
  
  
  RESULTS
  Sentinal node biopsy was less often applied in high-SES patients (multivariable analyses, ≤ 49 years: odds ratio (OR) 0.70 (95% CI: 0.56-0.89); 50-75 years: 0.85 (0.73-0.99)). Additionally, lymph node dissection was less common in low-SES patients aged ≥ 76 years (OR 1.34 (0.95-1.89)). Socioeconomic status-related differences in treatment were only significant in the age group 50-75 years. High-SES women with stage T1-2 were more likely to undergo breast-conserving surgery (+radiotherapy) (OR 1.15 (1.09-1.22) and OR 1.16 (1.09-1.22), respectively). Chemotherapy use among node-positive patients was higher in the high-SES group, but was not significant in multivariable analysis. Hormonal therapy was not related to SES.
  
  
  CONCLUSIONS
  Small but significant differences were observed in the use of SNB, lymph node dissection and breast-conserving surgery according to SES in Dutch breast cancer patients despite assumed equal access to health care.
authors.affiliation: Comprehensive Cancer Centre South, Eindhoven Cancer Registry, PO Box 231, 5600 AE, Eindhoven, The Netherlands. research@ikz.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: Aarts
authors.forename: V C
authors.initials: VC
authors.lastname: Hamelinck
authors.forename: E
authors.initials: E
authors.lastname: Bastiaannet
authors.forename: J W W
authors.initials: JW
authors.lastname: Coebergh
authors.forename: G J
authors.initials: GJ
authors.lastname: Liefers
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.forename: M
authors.initials: M
authors.lastname: van der Sangen
authors.forename: W J
authors.initials: WJ
authors.lastname: Louwman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D021701:Sentinel Lymph Node Biopsy; D012923:Social Class; D055815:Young Adult