Economic explorations of equality issues across the care pathway in breast cancer

Breast cancer places a high burden on the health system and on society as a whole. Incidence has been on the increase in recent decades and is projected to continue increasing in the coming years. There are constant advances in breast cancer screening and treatment which have a positive influence on outcome for women with breast cancer, however costs associated with these advancements are also increasing. It is important to look at breast cancer as a number of diseases which have varying causes, treatments and prognosis. Breast cancer screening, as part of a wider cancer control strategy, was introduced as a means to counteract the increasing loss of life and treatment costs associated with breast cancer. This thesis examines decisions made along various junctures of the breast cancer care pathway, from screening to initiation of treatment to outcomes for women with breast cancer with an emphasis on inequality. This analysis draws on a theoretical foundation of expected utility theory behaviour with respect to health, in order to gain insight into decisions surrounding health and health behaviour for breast cancer. We support this using empirical analysis Northern Ireland and Britain drawing upon a number of data sources. In order to obtain a clearer understanding of the role of inequality it is important not to focus on one juncture of the care pathway but examine it along various junctures. Overall findings of this examination are that while inequality is not found to exist in terms of income, there may be other factors which influence health behaviours and outcomes in relation to breast cancer which are likely to be highly correlated with socio-economic status and thereby income