Hwang and colleagues have observed that women undergoing mastectomy have a poorer disease-specific survival rate compared with women undergoing lumpectomy. One difference is that the women undergoing mastectomy have higher education/higher income (59% are in the upper socioeconomic quintiles for mastectomy compared with 50% for lumpectomy; 22% are in the lower quintiles for mastectomy compared with 29% for lumpectomy).
This difference in income may partially explain the difference in the survival rate. Several studies[2, 3] have demonstrated that higher income women consume more alcohol than lower income women, and it has been well established that alcohol consumption increases the risk of breast cancer. In addition, women with higher income are more likely to have received hormone-replacement therapy.
Alan I. Glaser, MD
Newton-Wellesley Hospital, Newton, Massachusetts