Abstract
To investigate patient, cancer and treatment characteristics in females with breast cancer from more remote areas of Australia, to better understand reasons for their poorer outcomes, bi-variable and multivariable analyses were undertaken using the National Breast Cancer Audit database of the Society of Breast Surgeons of Australia and New Zealand. Results indicated that patients from more remote areas were more likely to be of lower socio- economic status and be treated in earlier diagnostic epochs and at inner regional and remote rather than major city centres. They were also more likely to be treated by low case load surgeons, although this finding was only of marginal statistical significance in multivariable analysis (p=0.074). Patients from more remote areas were less likely than those from major cities to be treated by breast conserving surgery, as opposed to mastectomy, and less likely to have adjuvant radiotherapy when having breast conserving surgery. They had a higher rate of adjuvant chemotherapy. Further monitoring will be important to determine whether breast conserving surgery and adjuvant radiotherapy utilization increase in rural patients following the introduction of regional cancer centres recently funded to improve service access in these areas.
Highlights
The need for an emphasis on health needs of rural and remote Australians has long been recognized by health authorities
Patients from low socio-economic areas had a 10 times higher odds than Referral source those from high socio-economic areas of residing in Referral sources varied by area of residence
Most Australian women with early invasive breast cancer treated by surgeons in the BreastSurgANZ Breast Cancer Audit resided in major cities (70%), whereas 20% were from inner regional and 11% from outer regional and more remote areas
Summary
The need for an emphasis on health needs of rural and remote Australians has long been recognized by health authorities. Providing for specialized health service needs of rural and remote populations encounters difficulties relating both to geographic isolation and elevated health needs (Australian Health Ministers’ Conference, 2012). There are high numbers of Aboriginal and Torres Strait Islander residents with elevated mortality and morbidity rates (Australian Health Ministers’ Conference, 2012). Food supplies can be a challenge in remote areas, with poorer access to fresh fruit and vegetables (Australian Health Ministers’ Conference, 2012)
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