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Open Access Highly Accessed Research article

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

Rajah Supramaniam1*, Alison Gibberd2, Anthony Dillon3, David Eamon Goldsbury1 and Dianne L O’Connell1245

Author Affiliations

1 Cancer Research Division, Cancer Council NSW, Sydney, Australia

2 School of Public Health, The University of Sydney, Sydney, Australia

3 Institute for Positive Psychology and Education, Australia Catholic University, Sydney, Australia

4 School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia

5 School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia

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BMC Cancer 2014, 14:163  doi:10.1186/1471-2407-14-163

Published: 7 March 2014

Abstract

Background

Lower 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.

Methods

We 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.

Results

Of 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).

Conclusion

Preventing comorbidities and increasing rates of surgical treatment may increase breast cancer survival for NSW Aboriginal women.

Keywords:
Australia/epidemiology; Breast Neoplasms/epidemiology; Female health services; Indigenous; Survival rate