Educational Disparities in Breast Cancer Incidence, Survival, and Mortality in Belgium: A 2004-2013 Population Based Study with Insights into Mediating Reproductive Variables and Temporal Trends

Joachim Gotink , Vrije Universiteit Brussel
Michael Rosskamp, Belgian Cancer Registry
Freija Verdoodt, Belgian Cancer Registry
Sylvie Gadeyne, Vrije Universiteit Brussel

Breast cancer is the most prevalent cancer worldwide. Belgium shows high age-standardized incidence rates, but also high survival rates. Like many health outcomes, breast cancer has been associated with multiple factors of socioeconomic position. We aim to a) map educational differences in breast cancer incidence, survival and mortality, b) update earlier trends in breast cancer mortality in Belgium for the 2004-2013 period and c) investigate fertility indicators as mediating factors. Data consisted of a linkage at the population level between the 2001 Belgian Census, register data on mortality and cancer incidence data (2004-2013) from the Belgian Cancer Registry. We calculated age standardized rates, rate ratios (Poisson regression) and hazard ratios (Cox regression) and furthermore also applied the method of Excess Portion Eliminated (EPE) in a mediation analysis for the fertility indicators. We split our population in a pre- (younger than 50) and postmenopausal (50 or older) age group. Higher educated women have higher breast cancer incidence, but also higher all-cause and cause-specific survival chances; adding up to zero differences in breast cancer mortality in the postmenopausal group and lower breast cancer mortality in the premenopausal group. A notable shift in the social gradient has occurred, favoring higher-educated women in recent years. While fertility indicators play a role, their impact is less pronounced than expected, particularly on breast cancer incidence. We observed striking educational differences in breast cancer incidence, all-cause and cause-specific survival 5-years after diagnosis. Especially with regards to breast cancer survival there is ample opportunity for policy intervention.

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 Presented in Session 49. Social Inequalities in Sexual and Reproductive Health