title: Understanding the impact of socioeconomic differences in breast cancer survival in England and Wales: avoidable deaths and potential gain in expectation of life.
abstract: BACKGROUND
  Socioeconomic differences in cancer patient survival are known to exist for women diagnosed with breast cancer. Standard metrics tend not to place great emphasis on evaluating the actual impact of these differences.
  
  
  METHODS
  We used two alternative, but related, methods of reporting the impact of socioeconomic differences for breast cancer patients in England and Wales. We calculated the average gain in life years for each patient should socioeconomic differences in relative survival be removed and show how this is related to the number of all-cause deaths that could be postponed by removing socioeconomic differences in cancer patient survival.
  
  
  RESULTS
  Our results indicate that deprivation differences for women with breast cancer exist and result in women from more deprived areas losing a larger proportion of their life due to a diagnosis of cancer. We also estimate that on average 1.1 years could be gained for a 60 year old breast cancer patient in the most deprived group by improving their relative survival to match the least deprived group. However, our results also show that deprivation differences in general survival have a large impact on life expectancy; showing that over two-thirds of the gap in differential life expectancy is explained by differences in other-cause survival.
  
  
  CONCLUSIONS
  Socioeconomic differences in relative survival have an impact on life expectancy for patients and result in higher early mortality for more deprived patients. However, differences in general survival across socioeconomic groups explain a larger proportion of the deprivation gap in life expectancy for breast cancer patients.
authors.affiliation: Department of Health Sciences, University of Leicester, LE1 7RH, UK. Electronic address: mark.rutherford@le.ac.uk.
authors.forename: M J
authors.initials: MJ
authors.lastname: Rutherford
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm SE-171 77, Sweden.
authors.forename: T M-L
authors.initials: TM
authors.lastname: Andersson
authors.affiliation: King's College London, Section of Cancer Epidemiology and Population Health, London SE1 9RT, UK.
authors.forename: H
authors.initials: H
authors.lastname: Møller
authors.affiliation: Department of Health Sciences, University of Leicester, LE1 7RH, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm SE-171 77, Sweden.
authors.forename: P C
authors.initials: PC
authors.lastname: Lambert
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000473:pathology; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008875:Middle Aged; D012042:Registries; D012959:Socioeconomic Factors; D016019:Survival Analysis; D015996:Survival Rate; D014852:Wales / Q000453:epidemiology
keywords: Avoidable deaths; Life expectancy; Relative survival; Socioeconomic differences