Abstract
BackgroundNew Zealand has major ethnic disparities in breast cancer survival with Māori (indigenous people) and Pacific women (immigrants or descended from immigrants from Pacific Islands) faring much worse than other ethnic groups. This paper identified underlying factors and assessed their relative contribution to this risk differential.MethodsThis study involved all women who were diagnosed with primary invasive breast cancer in two health regions, covering about 40% of the national population, between January 2000 and June 2014. Māori and Pacific patients were compared with other ethnic groups in terms of demographics, mode of diagnosis, disease factors and treatment factors. Cox regression modelling was performed with stepwise adjustments, and hazards of excess mortality from breast cancer for Māori and Pacific patients were assessed.ResultsOf the 13,657 patients who were included in this analysis, 1281 (9.4%) were Māori, and 897 (6.6%) were Pacific women. Compared to other ethnic groups, they were younger, more likely to reside in deprived neighbourhoods and to have co-morbidities, and less likely to be diagnosed through screening and with early stage cancer, to be treated in a private care facility, to receive timely cancer treatment, and to receive breast conserving surgery. They had a higher risk of excess mortality from breast cancer (age and year of diagnosis adjusted hazard ratio: 1.76; 95% CI: 1.51–2.04 for Māori and 1.97; 95% CI: 1.67–2.32 for Pacific women), of which 75% and 99% respectively were explained by baseline differences. The most important contributor was late stage at diagnosis. Other contributors included neighbourhood deprivation, mode of diagnosis, type of health care facility where primary cancer treatment was undertaken and type of loco-regional therapy.ConclusionsLate diagnosis, deprivation and differential access to and quality of cancer care services were the key contributors to ethnic disparities in breast cancer survival in New Zealand. Our findings underscore the need for a greater equity focus along the breast cancer care pathway, with an emphasis on improving access to early diagnosis for Māori and Pacific women.
Highlights
New Zealand has major ethnic disparities in breast cancer survival with Māori and Pacific women faring much worse than other ethnic groups
Previous research found that, compared with their New Zealand European counterparts, Māori and Pacific women were more likely to be diagnosed with advanced breast cancer [10], along with being less likely to be diagnosed through screening, [11] and less likely to receive timely and optimal cancer treatment [12,13,14,15]
Compared with the non-Māori non-Pacific group, Māori and Pacific women were less likely to be diagnosed through screening and with stage 1 and grade 1 cancer and more likely to have ductal cancer compared to other ethnic groups
Summary
New Zealand has major ethnic disparities in breast cancer survival with Māori (indigenous people) and Pacific women (immigrants or descended from immigrants from Pacific Islands) faring much worse than other ethnic groups. Of great concern is large survival inequities that exist within the country, with the poorest outcomes experienced by Māori (indigenous people, constituting 14% of New Zealand women) and Pacific women (immigrants or descended from immigrants from Pacific Islands, constituting 7% of New Zealand women) [2]. Causes of ethnic disparities in cancer survival are complex and likely to include a range of factors related to patient demographics, tumour biology, and inequities in access, timeliness and quality of care along the cancer diagnosis and treatment pathway. Compared with New Zealand European women, Māori and Pacific women have a younger age distribution [5], and are more likely to live in deprived areas [6], to have comorbid conditions [7], to experience unmet need for health care [8] and to receive poorer quality health care [9]
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