Social inequalities in breast cancer mortality among French women: disappearing educational disparities from 1968 to 1996

We investigated the time trends in social inequalities in breast cancer mortality with an analysis by age at death and birth cohort using a representative 1% sample of the French population and four subcohorts ( 1968 - 1974, 1975 - 1981, 1982 - 1988 and 1990 - 1996). Causes of death were obtained by direct linkage with the French national death registry. Education was measured at the beginning of each period, and educational disparities in breast cancer mortality were studied among women aged 35 - 74 at the beginning of each period. In the 1970s, higher breast cancer mortality was found among higher educated women. This positive association progressively weakened and no association remained in the 1990s although it disappeared earlier among younger women. In an analysis by birth cohort, the same pattern was found among women born before 1925, whereas no association between education and mortality was observed among women born after 1925. Educational disparities in breast cancer mortality are currently changing and the previously observed positive gradient has disappeared. An important question is whether these relations are indirect, and due to changes in the prevalence of risk factors associated with education, but which we could not study.