{
  "abstract": "Introduction and aims Women residing in lower socioeconomic status (SES) areas have lower breast cancer survival but it is not clear how differences in the quality of care received contribute to these disparities. We compared adherence to clinical practice guidelines (CPG) for the diagnosis and treatment of breast cancer and subsequent breast cancer survival between women residing in lower versus higher SES areas.Methods We conducted a multicentre population-based study of all new cases of invasive breast cancer in women diagnosed 2010–2014 in six Spanish provinces with population-based cancer registries (n=3206). Clinical data were extracted in the framework of the European Cancer High Resolution studies and vital status follow-up covered a minimum of 5 years. SES of the patient’s residence was measured with the 2011 Spanish Deprivation Index. Adherence to CPG was measured with 16 indicators based on European and Spanish guidelines. Relative survival was modelled using flexible parametric models.Results There were no differences in the type of treatment received but women living in the lowest SES areas were less likely to undergo a sentinel lymph node biopsy, reconstruction after mastectomy, surgery within 30 days after pathological diagnosis and adjuvant treatment within 6 weeks after surgery. After accounting for demographic and clinical factors, women residing in lower SES areas had higher risk of death, HR=1.57 (95% CI 1.04, 2.36). Further accounting for adherence to CPG in the model, in particular having undergone a sentinel lymph node biopsy, eliminated the significant effect of SES.Conclusions Despite the overall coverage of the Spanish health system, women living in more deprived areas were less likely to receive care in line with CPG and had shorter survival.",
  "authors": [
    {
      "affiliations": [
        "Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain",
        "CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain",
        "Escuela Andaluza de Salud Pública, Granada, Spain",
        "Medical Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain"
      ],
      "name": "Dafina Petrova"
    },
    {
      "affiliations": [
        "Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain",
        "CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain",
        "Escuela Andaluza de Salud Pública, Granada, Spain"
      ],
      "name": "Daniel Redondo-Sánchez"
    },
    {
      "affiliations": [
        "Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain",
        "CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain",
        "Escuela Andaluza de Salud Pública, Granada, Spain"
      ],
      "name": "Miguel Rodríguez-Barranco"
    },
    {
      "affiliations": [
        "CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain",
        "Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Catalan Institute of Oncology (ICO). Girona Biomedical Research Institute (IDIBGI-CERCA), Girona, Spain",
        "Josep Carreras Leukemia Research Institute, Girona, Spain",
        "Department of Medical Sciences, Medical School, University of Girona, Girona, Spain"
      ],
      "name": "Rafael Marcos-Gragera"
    },
    {
      "affiliations": [
        "CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain",
        "Registro de Cáncer de Navarra, Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain"
      ],
      "name": "Marcela Guevara"
    },
    {
      "affiliations": [
        "Tarragona Cancer Registry, Hospital Universitari Sant Joan de Reus, Reus, Spain"
      ],
      "name": "Marià Carulla"
    },
    {
      "affiliations": [
        "Basque Country Cancer Registry, Basque Government Department of Health, Vitoria-Gasteiz, Spain"
      ],
      "name": "Arantza López de Munain"
    },
    {
      "affiliations": [
        "Castellón Cancer Registry, Health Department Generalitat Valenciana, Castellón, Spain"
      ],
      "name": "Ana Vizcaíno"
    },
    {
      "affiliations": [
        "Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Catalan Institute of Oncology (ICO). Girona Biomedical Research Institute (IDIBGI-CERCA), Girona, Spain"
      ],
      "name": "Sonia del Barco"
    },
    {
      "affiliations": [
        "Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain",
        "Medical Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain"
      ],
      "name": "Encarnación González-Flores"
    },
    {
      "affiliations": [
        "Instituto de Salud Carlos III, Madrid, Spain"
      ],
      "name": "Marina Pollán"
    },
    {
      "affiliations": [
        "Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain",
        "CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain",
        "Escuela Andaluza de Salud Pública, Granada, Spain"
      ],
      "name": "María-José Sánchez"
    }
  ],
  "title": "Socioeconomic inequalities in adherence to clinical practice guidelines and breast cancer survival: a multicentre population-based study in Spain",
  "uid": "6b08a080-9ef6-5475-88c9-88980b2a01d6"
}