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Title: How does deprivation affect breast cancer outcomes and patterns of care?
Author: Bracegirdle, Gillian Ruth
ISNI:       0000 0001 3474 4196
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2008
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Background: Approximately 30,000 women are diagnosed with breast cancer in England and Wales each year. There are differences in incidence and survival rates for women from differing socioeconomic backgrounds. Affluent women have a higher incidence ofbreast cancer, however, survival is lower in deprived women. Since research has generally linked these two findings, it was hypothesised that these results would also be found in a small area in the North West ofEngland. Aims and Objectives: In light of previous research findings, the purpose of this study was to: examine inequality in incidence, mortality and survival of breast cancer in the 1990's for the localities of Halton and Warrington; identify the factors that influence the incidence, mortality and survival of breast cancer in affluent and deprived areas; and, investigate the differences in women's breast cancer journeys throughout the locality of Halton and Warrington PCTs. Methods: The study was divided into two parts, the first part being an epidemiological small area analysis which studied incidence, mortality and survival from breast cancer in Warrington and Halton in the North West of England over a twelve year period. The second part ofthe study involved the interviewing of eighty women in order to gain a more indepth knowledge of their breast cancer journey and chart the process by which they reached the point ofdiagnosis and treatments. Results: The first part of the study revealed, the lowest incidence of breast cancer was found in the affluent women throughout the 1990's. In keeping with the literature, large increases were seen in the five year survival rates for North Cheshire in the 1990's. The screening results indicated that the screening uptake was higher in the affluent women, although during the 1990's the gap narrowed. Grade of cancer at diagnosis rather than deprivation accounted for variation in survival. The second part of the study revealed, there were delays from symptom recognition to diagnosis and diagnosis to treatment, however, the main reason for the delay in the process was attributable to the respondent rather than health system factors. This study did not find delay differences between deprivation groups. A key element in the delay in seeking health care was that of past experiences. The main difference between the affluent and deprived respondents was a lack of knowledge of breast cancer in the deprived group. Both parts of the study found no evidence of women from deprived areas presenting with more advanced cancer, which can impact on mortality and survival rates. Conclusion: This study found that grade was more important than deprivation when assessing variation in survival. Delay in seeking health care with symptoms of breast cancer did not vary by deprivation groups. Deprivation was not consistently associated with less favourable help seeking behaviours or outcomes.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available