What Is the Evidence Globally for Culturally Safe Strategies to Improve Breast Cancer Outcomes for Indigenous Women in High Income Countries? A Systematic Review.

Vita Christie,Christopher Pyke,Debbie Green,John Skinner,Janaki Amin,Kylie Gwynne,Deb Mccowen,Karen Littlejohn

doi:10.3390/ijerph18116073

Abstract

The aim was to systematically assess the evidence on whether cultural safety affects breast cancer outcomes with regards to care for Indigenous women in high income countries. We conducted a systematic review in accordance with PRISMA guidelines of peer-reviewed articles in Medline, EMBASE, CINAHL, Scopus, Web of Science, Proquest Sociology and Informit Rural health database and Indigenous collection databases. Key inclusion criteria were: adult female patients with breast cancer; high income country setting; outcome measure, including screening, diagnosis, treatment and follow up care. A total of 15 were selected. We developed a Community Engagement assessment tool in consultation with aboriginal researchers, based on the National Health and Medical Research Councils’ community engagement guidelines, against which studies were appraised. This novel element allowed us to evaluate the literature from a new and highly relevant perspective. Thematic analysis of all 15 studies was also undertaken. Despite limited literature there are evidence-based strategies that are likely to improve outcomes for Indigenous women with breast cancer in high income countries and indicate that culture makes a positive difference. It is also clear that strong Indigenous community leadership and governance at all stages of the research including design is an imperative for feasibility.

Highlights

Breast cancer is the most commonly diagnosed cancer in Australia, representing 28%of all cancer incidence in women and the second highest number of deaths [1]
314 articles remained, which were subjected to an abstract review, with further exclusions made: focused on family experience only, studies including nonIndigenous population groups, related to clinical trials only, discussion of HPV/Cervical cancer only, speaker abstracts, conference abstracts, PhD dissertations, prevention focus only, service provider focus, systematic reviews, reviews, no outcome data, all cancers, men and women, specific cancer(not breast) only, regarding challenges within the health system but not for community, format(such as book excerpt) or because they did not use primary data sources or were about cancer in general. 15 remained and were subject to the community engagement tool and a thematic analysis
The vast majority of Indigenous health research is descriptive or epidemiological [44] and further research, including on breast cancer, is needed to ensure that health interventions are efficacious for Indigenous peoples. This literature in this review found that culture makes a significant difference to Indigenous peoples in wealthy countries when it comes to cancer in general

Summary

Introduction

Breast cancer is the most commonly diagnosed cancer in Australia, representing 28%of all cancer incidence in women and the second highest number of deaths [1]. Breast cancer is the most commonly diagnosed cancer in Australia, representing 28%. Mortality due to breast cancer has declined significantly over recent decades. This coincides with improved rates of early detection following introduction of national population-based mammography screening programs [2], yet Aboriginal and Torres Strait Islander women in Australia continue to face high mortality rates, despite an incidence of breast cancer on par with or less than non-Indigenous women [1]. Between 1998 and 2013, there has been no significant decrease in the Aboriginal mortality rates for breast cancer [1]. Uptake of screening has increased over time among both non-Indigenous and Indigenous populations in Australia, a significant gap remains.

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