Increasing rates of surgical treatment and preventing comorbidities may increase breast cancer survival for Aboriginal women

Rajah Supramaniam,Dianne L O’Connell,Anthony Dillon,David Eamon Goldsbury,Alison Gibberd

doi:10.1186/1471-2407-14-163

Rajah Supramaniam, Dianne L O’Connell + Show 3 more

Open Access

https://doi.org/10.1186/1471-2407-14-163

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Abstract

BackgroundLower breast cancer survival has been reported for Australian Aboriginal women compared to non-Aboriginal women, however the reasons for this disparity have not been fully explored. We compared the surgical treatment and survival of Aboriginal and non-Aboriginal women diagnosed with breast cancer in New South Wales (NSW), Australia.MethodsWe analysed NSW cancer registry records of breast cancers diagnosed in 2001–2007, linked to hospital inpatient episodes and deaths. We used unconditional logistic regression to compare the odds of Aboriginal and non-Aboriginal women receiving surgical treatment. Breast cancer-specific survival was examined using cumulative mortality curves and Cox proportional hazards regression models.ResultsOf the 27 850 eligible women, 288 (1.03%) identified as Aboriginal. The Aboriginal women were younger and more likely to have advanced spread of disease when diagnosed than non-Aboriginal women. Aboriginal women were less likely than non-Aboriginal women to receive surgical treatment (odds ratio 0.59, 95% confidence interval (CI) 0.42-0.86). The five-year crude breast cancer-specific mortality was 6.1% higher for Aboriginal women (17.7%, 95% CI 12.9-23.2) compared with non-Aboriginal women (11.6%, 95% CI 11.2-12.0). After accounting for differences in age at diagnosis, year of diagnosis, spread of disease and surgical treatment received the risk of death from breast cancer was 39% higher in Aboriginal women (HR 1.39, 95% CI 1.01-1.86). Finally after also accounting for differences in comorbidities, socioeconomic disadvantage and place of residence the hazard ratio was reduced to 1.30 (95% CI 0.94-1.75).ConclusionPreventing comorbidities and increasing rates of surgical treatment may increase breast cancer survival for NSW Aboriginal women.

Highlights

Lower breast cancer survival has been reported for Australian Aboriginal women compared to non-Aboriginal women, the reasons for this disparity have not been fully explored
We found that in New South Wales (NSW), Australia, Aboriginal women diagnosed with breast cancer were significantly less likely to receive surgical treatment and had poorer survival than non-Aboriginal women
After accounting for differences in age at diagnosis, year of diagnosis and spread of disease Aboriginal women had a 67% higher risk of death from breast cancer than non-Aboriginal women. This increased risk was reduced after accounting for differences in the potentially modifiable factors of surgical treatment received and comorbidities. These results suggest that increasing rates of surgical treatment and preventing comorbidities may increase the survival of Aboriginal women diagnosed with breast cancer in NSW

Summary

Introduction

Lower breast cancer survival has been reported for Australian Aboriginal women compared to non-Aboriginal women, the reasons for this disparity have not been fully explored. We compared the surgical treatment and survival of Aboriginal and non-Aboriginal women diagnosed with breast cancer in New South Wales (NSW), Australia. It is generally reported that while breast cancer incidence in Aboriginal women is lower than in non-Aboriginal women [4,5,6,7,8], their population mortality rate from the disease is either lower [9] or similar, suggesting that the in areas of higher socioeconomic disadvantage, and to live in areas further from major cancer treatment centres [2]. New South Wales (NSW) is the most populous state in Australia, with over 6.8 million residents [11] It has the largest number of Aboriginal residents (148 178), representing approximately 29% of the total Australian Aboriginal population [11]. Aboriginal people in NSW are more likely to live in metropolitan areas than those in other Australian states with Aboriginal populations of over 50,000 people. Aboriginal people in NSW are still less likely to live in metropolitan areas (43%) than non-Aboriginal people (73%) [11]

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