Abstract
Background:Significant improvements in breast cancer survival have been made in the past few decades in many developed countries including Australia with a five-year relative survival of 90%. The aim of the present study is to obtain a brief estimate of the relative importance of demographic factors such as rurality, socio-economic standard and ethnicity versus traditional risk factors for women diagnosed with breast cancer in Far North Queensland, Australia. Methods:This was a retrospective longitudinal study of all women diagnosed with their first episode of breast cancer in 1999-2013 in Far North Queensland, Australia. Cox proportional hazards regression analysis was used to identify factors independently associated with mortality for women with any type of breast cancer (in situ or invasive) and for women with invasive cancer. Life tables were used to assess five and ten-year absolute survival. Standard linear regression and binary logistic regression were used to identify any association between demographic factors and late presentation. Results:Five and ten-year absolute survival was 0.90 and 0.86 respectively. Aboriginal and Torres Strait Islander status, remoteness of area of residence, and socioeconomic status were not associated with more advanced disease at presentation or increased risk of breast cancer death. Only traditional risk factors such as increased tumour size, absence of progesterone receptor, high tumour grade and presence of metastasis in axillary lymph nodes were associated with increased risk of breast cancer death. Conclusion:The effect of the classical risk factors on breast cancer mortality outweighs the effects of demographic factors. The fact that ethnicity, remoteness and socioeconomic status is not associated with late presentation or breast cancer death suggests that given appropriate resources it may be possible to close the gap of inequalities in breast cancer.
Highlights
Significant improvements in breast cancer survival have been made in the past few decades in many developed countries including Australia with a five-year relative survival of 90% (Ghoncheh et al, 2016)
The aim of the present study is to obtain a brief estimate of the relative importance of demographic factors such as rurality, socio-economic standard and ethnicity versus traditional risk factors for women diagnosed with breast cancer in Far North Queensland, Australia
In Australia there has been poor outcomes for women living in rural and remote areas compared to major cities, women with lower socioeconomic status and Aboriginal and Torres Strait Islander women compared to their respective counterparts (Diaz et al, 2015; AIHW, 2017a)
Summary
Significant improvements in breast cancer survival have been made in the past few decades in many developed countries including Australia with a five-year relative survival of 90% (Ghoncheh et al, 2016). In Australia there has been poor outcomes for women living in rural and remote areas compared to major cities, women with lower socioeconomic status and Aboriginal and Torres Strait Islander women compared to their respective counterparts (Diaz et al, 2015; AIHW, 2017a). Reasons for these disparities include reduced access to screening services leading to later presentation of disease or poorer tumour characteristics, reduced access to appropriate medical services contributing to treatment delays or inability to incomplete treatment, poor health literacy leading to lack of knowledge of breast cancer symptoms, importance of screening and treatment. The fact that ethnicity, remoteness and socioeconomic status is not associated with late presentation or breast cancer death suggests that given appropriate resources it may be possible to close the gap of inequalities in breast cancer
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