Abstract
BackgroundNSW has a multicultural population with increasing migration from South East Asia, the Western Pacific and Eastern Mediterranean.ObjectiveTo compare cancer stage, treatment (first 12 months) and survival for 12 country of birth (COB) categories recorded on the population-based NSW Cancer Registry.DesignHistoric cohort study of invasive breast cancers diagnosed in 2003–2016.PatientsData for 48,909 women (18+ ages) analysed using linked cancer registry, hospital inpatient and Medicare and pharmaceutical benefits claims data.MeasurementComparisons by COB using multivariate logistic regression and proportional hazards regression with follow-up of vital status to April 30th, 2020.ResultsCompared with the Australia-born, women born in China, the Philippines, Vietnam and Lebanon were younger at diagnosis, whereas those from the United Kingdom, Germany, Italy and Greece were older. Women born in China, the Philippines, Vietnam, Greece and Italy lived in less advantaged areas. Adjusted analyses indicated that: (1) stage at diagnosis was less localised for women born in Germany, Greece, Italy and Lebanon; (2) a lower proportion reported comorbidity for those born in China, the Philippines and Vietnam; (3) surgery type varied, with mastectomy more likely for women born in China, the Philippines and Vietnam, and less likely for women born in Italy, Greece and Lebanon; (4) radiotherapy was more likely where breast conserving surgery was more common (Greece, Italy, and Lebanon) and the United Kingdom; and (5) systemic drug therapy was less common for women born in China and Germany. Five-year survival in NSW was high by international standards and increasing. Adjusted analyses indicate that, compared with the Australian born, survival from death from cancer at 5 years from diagnosis was higher for women born in China, the Philippines, Vietnam, Italy, the United Kingdom and Greece.ConclusionsThere is diversity by COB of stage, treatment and survival. Reasons for survival differences may include cultural factors and healthier migrant populations with lower comorbidity, and potentially, less complete death recording in Australia if some women return to their birth countries for treatment and end-of-life care. More research is needed to explore the cultural and clinical factors that health services need to accommodate.
Highlights
New South Wales (NSW) has a multicultural population with increasing migration from South East Asia, the Western Pacific and Eastern Mediterranean
Compared with the Australia-born, women born in China, the Philippines, Vietnam and Lebanon were younger at diagnosis, whereas those from the United Kingdom, Germany, Italy and Greece were older
Adjusted analyses indicated that: (1) stage at diagnosis was less localised for women born in Germany, Greece, Italy and Lebanon; (2) a lower proportion reported comorbidity for those born in China, the Philippines and Vietnam; (3) surgery type varied, with mastectomy more likely for women born in China, the Philippines and Vietnam, and less likely for women born in Italy, Greece and Lebanon; (4) radiotherapy was more likely where breast conserving surgery was more common (Greece, Italy, and Lebanon) and the United Kingdom; and (5) systemic drug therapy was less common for women born in China and Germany
Summary
NSW has a multicultural population with increasing migration from South East Asia, the Western Pacific and Eastern Mediterranean. Australia had a high relative survival from breast cancer at 93% 5 years from diagnosis in 2012–2016 [1, 2] This is a marked increase from the corresponding 74% in 1982–87 [3] and was accompanied by a 37% decline at population level in age-standardized breast cancer mortality [4]. Survival from breast cancer in Australia, as indicated by the complement of the breast cancer mortality to incidence ratio (1-M/I), is at the high end of the international scale [5] This varies across the population, with lower survival at each end of the age range and in women from lower socioeconomic areas [2, 6]. While women from culturally and linguistically diverse (CALD) backgrounds have generally experienced a lower screening participation, differences in follow-up treatment access and quality for these women compared with the Australian-born are largely unknown [8, 9]
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