Achieving High Breast Cancer Survival for Women in Rural and Remote Areas.

BACKGROUND: Significant improvements in breast cancer survival have been made in the past few decades in many developed countries including Australia with a five-year relative survival of 90%. The aim of the present study is to obtain a brief estimate of the relative importance of demographic factors such as rurality, socio-economic standard and ethnicity versus traditional risk factors for women diagnosed with breast cancer in Far North Queensland, Australia. METHODS: This was a retrospective longitudinal study of all women diagnosed with their first episode of breast cancer in 1999-2013 in Far North Queensland, Australia. Cox proportional hazards regression analysis was used to identify factors independently associated with mortality for women with any type of breast cancer (in situ or invasive) and for women with invasive cancer. Life tables were used to assess five and ten-year absolute survival. Standard linear regression and binary logistic regression were used to identify any association between demographic factors and late presentation. RESULTS: Five and ten-year absolute survival was 0.90 and 0.86 respectively. Aboriginal and Torres Strait Islander status, remoteness of area of residence, and socioeconomic status were not associated with more advanced disease at presentation or increased risk of breast cancer death. Only traditional risk factors such as increased tumour size, absence of progesterone receptor, high tumour grade and presence of metastasis in axillary lymph nodes were associated with increased risk of breast cancer death. CONCLUSION: The effect of the classical risk factors on breast cancer mortality outweighs the effects of demographic factors. The fact that ethnicity, remoteness and socioeconomic status is not associated with late presentation or breast cancer death suggests that given appropriate resources it may be possible to close the gap of inequalities in breast cancer.

Retrospective, 5-year surgical audit comparing breast cancer in indigenous and non-indigenous women in Far North Queensland.

BACKGROUND: Breast cancer is the third leading cause of cancer deaths in Aboriginal women after cervical and lung cancer. METHODS: A retrospective 5-year surgical audit comparing breast cancer in indigenous and non-indigenous women in Far North Queensland was undertaken. RESULTS: The mean age at diagnosis was similar for indigenous (54.0 years) and non-indigenous (55.4 years) women. Indigenous women presented with slightly larger tumours (mean 32.2 mm vs 23 mm; P = 0.07). More indigenous women had involved lymph nodes (P = 0.03). Despite larger tumour size, indigenous women were considered suitable for breast conservation surgery at a rate similar to the non-indigenous population. CONCLUSIONS: Indigenous women present with more advanced breast cancer in Far North Queensland despite similar detection rates among the screened indigenous and non-indigenous population. Indigenous women received similar rates of breast conservation surgery. Differences in mortality rates will require further study.