Are neglected breast cancer relates to lifestyle and socioeconomic environment?
Authors: Anne-lise Farcy, Lacaze Jean Louis, Charlotte Vaysse, Cyrille Delpierre, Gabrielle Selmes, Mony Ung, Clemence BRAC de la PERRIERE, Carole Domenech, Eleonora De Maio, Bastien Cabarrou, Florence Tremollieres, Florence Dalenc
Journal: Journal of Clinical Oncology (2021)

e18542 Background: The incidence of patients with neglected breast cancer (NBC) in high-income countries remains an issue. It may be important to clarify their characteristics to adapt prevention policy. The purpose of present study was to describe the clinical and socio-economic features of patients with NBC at diagnosis. Methods: We conducted a retrospective analysis of 110 patients treated in our institution between January 2018 and December 2019 for a NBC. Diagnosis of NBC was made when patients deliberately delayed the first consultation for more than 3 months, despite the suspicious nature of the abnormality, or when breast cancer was described as neglected by physicians. Locally advanced breast cancer related to diagnostic delay and those for which the patients did not initially worry, were not retained. Results: The median age was 70 years [31-98], 51.8 % had more than 70 years. Delay between the first signs and the first consultation, was 3 to 6 months for 17 patients (20.5%), 6 and 12 months for 24 (21.1%) and more than 1 year for 36 (43.4%). 51 (47.2 %) patients lived alone, 52 (48.1%) lived with a third person and 5 (4.6%) were institutionalized. 47 (44.3%) were in a relationship, 27 (25.5%) were single and 32 (30.2%) were widow or separated, 84 (76.4%) had at least one child, 79 (76.4%) patients had at least one caregiver. 63 patients (57.3%) had regular medical follow-up due to chronic disease. 26 (23.6%) had psychiatric disorders. Concerning socio-economic position, 57 (51%) were employees, 16 (14%) were executive or intermediate profession, 11 (10%) had a higher intellectual profession, 11 (10%) were workers, 9 (10%) did not have an occupation, 3 (3%) were craftsmen, shopkeepers, or company managers and 3 (3%) were farmers. According to the score of the French European Deprivation Index (FEDI), 60 (55.6%) lived in areas of low to extremely low socio-economic level. In comparison with a series of 89 patients, treated for a non-neglected BC, NBC was more prevalent among single, separated, or widowed patients (p=0,0002), those living alone or institutionalized (p=0,01). It also concerns childless patients (p=0,02) and those who had no caregiver (p=0,02) or with psychiatric disorder (p=0,004). Employees and workers are more represented among negligent patients (p=0,01). There was no statistical difference in socioeconomic feature according to the FEDI (p=0,2). In multivariate analysis, living alone and psychiatric disorders were independent risk factors for NBC (respectively: OR= 2,27, IC95% [1,11-5,65], p=0,02; OR= 6,88, IC95% [1,76;26,84], p=0,005). Conclusions: We present the largest cohort of NBC. Patients with NBC appear to be more precarious psychologically, socially, and economically. Prospective studies are necessary to strengthen and deepen the associations found to optimize the screening policy and the education of physicians.