title: Absence of socioeconomic inequalities in access to good-quality breast cancer treatment within a population-wide screening programme in Turin (Italy).
abstract: Several studies suggest that population-based breast cancer screening programmes might help reduce social inequalities in breast cancer survival both by increasing early diagnosis and by improving access to effective treatments. To start disentangling the two effects, we evaluated social inequalities in quality of treatment of screen-detected breast cancer in the city of Turin (Italy). Combining data from the Audit System on Quality of Breast Cancer Treatment and the Turin Longitudinal Study, we analysed 2700 cases in the screening target age class 50-69 diagnosed in the period 1995-2008. We selected 10 indicators of the pathway of care, relative to timeliness and appropriateness of diagnosis and treatment, and three indicators of socioeconomic position: education, occupational status and housing characteristics. For each indicator of care, relative risks of failure were estimated by robust Poisson regression models, controlling for calendar period of diagnosis, size of tumour and activity volume of the surgery units. The principal predictor of failure of the good care indicators was the calendar period of diagnosis, with a general improvement with time in the quality of diagnosis and treatment, followed by size of the tumour and volume of activity. Socioeconomic indicators show only a marginal independent effect on timeliness indicators. The observed associations of quality indicators with socioeconomic characteristics are lower than expected, suggesting a possible role of the screening programme in reducing disparities in the access to good-quality treatments thanks to its capability to enter screen-detected women into a protected pathway of care.
authors.affiliation: aEpidemiology Unit, ASL TO3 Piedmont Region, Grugliasco bCancer Epidemiology Unit, University Hospital 'Città della Salute e della Scienza di Torino', CPO Piemonte cDepartment of Clinical and Biological Sciences, University of Turin, Turin, Italy dDepartment of Public Health and Policy, Division of Public Health, University of Liverpool, Liverpool, UK.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Zengarini
authors.forename: Antonio
authors.initials: A
authors.lastname: Ponti
authors.forename: Mariano
authors.initials: M
authors.lastname: Tomatis
authors.forename: Denise
authors.initials: D
authors.lastname: Casella
authors.forename: Livia
authors.initials: L
authors.lastname: Giordano
authors.forename: Maria P
authors.initials: MP
authors.lastname: Mano
authors.forename: Nereo
authors.initials: N
authors.lastname: Segnan
authors.forename: Margaret
authors.initials: M
authors.lastname: Whitehead
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costa
authors.forename: Teresa
authors.initials: T
authors.lastname: Spadea
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors