Explaining breast cancer mortality in England: The effect of socioeconomic factors and health care services

England has the worst mortality rate for breast cancer in the developed world, Using area-level data for 145 health districts in England, this study seeks to explain variations in breast cancer mortality among women aged 50-64 years in the period before the National Breast Screening Programme became operational, It is found that socioeconomic and behavioural factors had a larger effect on mortality than did health care inputs, This might be explained both by inadequacies in the data, and by the fact that, in the absence of screening, cancers tend to be detected at a later stage, by which time the chances of a successful outcome are reduced, It is suggested that the impact of health care services in reducing mortality will increase in the future as screening becomes widespread and results in earlier detection and treatment, The prioritization of screening is central to achieving the reductions in mortality from breast cancer specified in the Health of the Nation targets.