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Inequities in Breast Cancer and The Index of Multiple Deprivation

Inequities in Breast Cancer and The Index of Multiple Deprivation

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Project Summary

Breast cancer is the most commonly diagnosed cancer among women in the UK, with significant disparities in diagnostic incidence across different socioeconomic groups. People with cancer diagnosed at an early stage (stage 1 or 2) have better survival than people diagnosed at a later stage (stage 3 or 4)1. People living in more deprived areas have significantly higher cancer mortality rates compared with those in less deprived areas2.

LVC have chosen to take a more detailed look at inequities in breast cancer and have identified a possible correlation between the index of multiple deprivation and diagnosis rate in breast cancer

Key Findings in This Report3:

  1. The breast cancer screening programme is effective at detecting breast cancer in women at early stages. This well established programme and earlier detection undoubtably leads to better outcomes for patients.
  2. LVC has identified that 1 in 5 women diagnosed with breast cancer have missing data leading to challenges in staging. The impact that this has on treatment choices and outcome for patients is unclear. the proportion of these missing and unstaged patients varies per ICB.
  3. A strong inverse correlation exists. The most deprived quintile has the lowest breast cancer incidence rates, whereas the least deprived quintile has the highest breast cancer incidence rates.

In 2022, England recorded 50,633 new cases of female breast cancer. NHS breast cancer screening is effective in detecting cancer at an early stage among women in the eligible age groups. Data shows a marked difference in the stage at diagnosis between those included in the screening programme and those who are not. Women within the screening age range are more likely to be diagnosed at an early stage, whereas late-stage diagnoses occur more evenly across all age groups outside the programme. Among these cases, one in five women had missing staging data, which may have implications for the treatment they receive.

Missing Data: refers to cases where vital information is unavailable, hindering proper staging despite the cancer originating from a stageable site.
NHS Breast Cancer Screening: all women between the ages of 50 and 71 are invited for breast screening every three years.

The screen below shows a clear inverse relationship between breast cancer incidence rates and deprivation levels. The most deprived quintile has the lowest incidence rates, while the least deprived quintile has the highest incidence rates.

The image below shows that breast cancer incidence rates differ markedly between the most and least deprived groups. Each ICB can be divided into five deprivation quintiles and assessed independently.

The screen below summarises female breast cancer cases by hormone receptor status across different age groups in England in 2022. ER-positive breast cancer is the most prevalent type, particularly among women aged 50 to 69. Triple-negative and HER2-only cases are less common but remain clinically significant due to differing treatment approaches. Notably, a substantial number of cases with unknown hormone receptor status.

Recommendations: Closing the Gap in Breast Cancer Outcomes
  1. Identification of ICBS with the greatest inequities:
    Interrogating the existing data to identify which ICBs seem to have the greatest proportion of missing patients and understanding which NHS Trusts and services are in the greatest need for support.
  2. Work with local services:
    Work to improve services and access to patients who’s data may be missing or incomplete. In particular, consider how diagnosis rate can be improved in areas of higher deprivation.
  3. Industry / NHS partnerships:
    Strengthen the collaboration between the Pharmaceutical industry and the NHS to better understand the data and the possible solutions in order to implement the most impactful solutions.
References
  1. NHS England (2023). Cancer survival in England, cancers diagnosed 2016 to 2020, followed up to 2021.
  2. Cancer Research UK. Cancer in the UK 2025: Socioeconomic deprivation. Published February 2025.
  3. Data On File. LVC Data Analytics Team.

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