Cancer incidence, mortality, and stage at diagnosis in First Nations living in Manitoba.

BACKGROUND: In the present study, we examined breast (bca) and colorectal cancer (crc) incidence and mortality and stage at diagnosis for First Nations (fn) individuals and all other Manitobans (aoms). METHODS: Several population-based databases were linked to determine ethnicity and to calculate age-standardized incidence and mortality rates. Logistic regression was used to compare bca and crc stage at diagnosis. RESULTS: From 1984-1988 to 2004-2008, the incidence of bca increased for fn and aom women. Breast cancer mortality increased for fn women and decreased for aom women. First Nations women were significantly more likely than aom women to be diagnosed at stages iii-iv than at stage i [odds ratio (or) for women ≤50 years of age: 3.11; 95% confidence limits (cl): 1.20, 8.06; or for women 50-69 years of age: 1.72; 95% cl: 1.03, 2.88). The incidence and mortality of crc increased for fn individuals, but decreased for aoms. First Nations status was not significantly associated with crc stage at diagnosis (or for stages i-ii compared with stages iii-iv: 0.98; 95% cl: 0.68, 1.41; or for stages i-iii compared with stage iv: 0.91; 95% cl: 0.59, 1.40). CONCLUSIONS: Our results underscore the need for improved cancer screening participation and targeted initiatives that emphasis collaboration with fn communities to reduce barriers to screening and to promote healthy lifestyles.

Wait times from presentation to treatment for colorectal cancer: a population-based study.

BACKGROUND: The wait time from cancer diagnosis to treatment has been a recent focus of cancer care in Canada. OBJECTIVE: To examine the trends in wait times from patient presentation to treatment (overall health system wait time [OWT]) for colorectal cancer (CRC). METHODS: Patients with colorectal adenocarcinomas, diagnosed between 2001 and 2005, and their first definitive treatments were identified from the population-based Manitoba Cancer Registry (Winnipeg, Manitoba). By linkage to Manitoba Health and Healthy Living's administrative databases, a patient's first gastrointestinal investigation (abdominal radiological imaging, lower gastrointestinal endoscopy or fecal occult blood test) before CRC diagnosis was identified. The index contact with the health care system was estimated from the date of the visit with the physician who ordered the first gastroenterological investigation. The OWT was defined as the time from the index contact to the first treatment, while diagnostic delay was defined as the time from the index contact to the diagnosis of CRC. Multivariate Cox regression analysis was performed to determine independent predictors of OWT. RESULTS: The OWT was estimated for 2552 cases of CRC over the five years that were examined. The median OWT increased from 61 days in 2001 to 95 days in 2005 (P<0.001). Most of the increase was in diagnostic wait times (median of 44 days in 2001 versus 64 days in 2005 [P<0.001]). Year of diagnosis, older age, urban residence and diagnosis at a teaching facility were independent predictors of OWT. CONCLUSIONS: The OWT from presentation to treatment of CRC in Manitoba steadily increased between 2001 and 2005, mostly due to diagnostic delays.

Radiation treatment waiting times for breast cancer patients in Manitoba, 2001 and 2005.

INTRODUCTION: Our study examined the wait time from ready-to-treat to radiation therapy for cohorts of breast cancer patients requiring adjuvant radiation therapy in 2001 and in 2005 after the implementation of strategies to reduce wait times for radiation treatment. We also examined the overall time from diagnosis to radiation treatment and whether distance from the cancer treatment centre or month of referral had an effect on wait times. METHODS: This population-based retrospective study looked at representative samples of women newly diagnosed with breast cancer in 2001 and 2005. Patients who required radiation treatment to the breast or chest wall were followed from first contact to the start of radiation treatment. RESULTS: Time from ready-to-treat to first radiation treatment was significantly reduced for patients in 2005 as compared with 2001, regardless of whether chemotherapy was administered before radiation treatment. Time from diagnosis to radiation treatment was not different by year for those who received radiation only. Time from diagnosis to chemotherapy was significantly longer in 2005. No effect of month of diagnosis on wait times was observed. INTERPRETATION: A significant improvement in the median wait time from ready-to-treat to first radiation treatment was noted from 2001 to 2005. This improvement may be attributable to measures taken to reduce such waits. However, we observed an increase in the median time from diagnosis to referral and from referral to consultation with medical or radiation oncology (or both), so that the overall time from diagnosis to radiation treatment was not different. Although specific intervals related to radiation treatment delivery were improved, the entire trajectory of breast cancer care experienced by patients needs to be considered.

The impact of margin status on local recurrence following breast conserving therapy for invasive carcinoma in Manitoba.

BACKGROUND: Histologically positive margins are generally considered unacceptable with breast conserving therapy (BCT) given the increased risk of local recurrence (LR). What constitutes an adequate negative margin remains controversial. Margin status was explored as a predictor of LR post-BCT. METHODS: Manitoba women with loco-regional progression and/or mastectomy >6 months following BCT for Stage I/II invasive cancer (1995-2004) were identified from the Manitoba Cancer Registry; LR cases were confirmed by chart review. Three controls per case were matched by age, grade, stage, and adjuvant chemotherapy use. Margin status was categorized as histologically positive, < or =1 mm, < or =2 mm or >2 mm. Conditional logistic regression determined the odds ratio of LR by margin category. RESULTS: There were 50 LR cases in 3,017 patients who underwent BCT, with a median follow-up of 60 months. Wider margins were associated with a non-significant reduction in LR: >1 mm versus < or =1 mm (OR 0.69; 95% CI 0.28-1.69) and >2 mm versus < or =2 mm (OR 0.90; 95% CI 0.44-1.84). CONCLUSIONS: No clear benefit to wider histologically negative margins is demonstrated.

Same question, different data source, different answers? Data source agreement for surgical procedures on women with breast cancer.

This study assessed the accuracy of the Manitoba Cancer Registry (MCR) and two administrative data sources, the Manitoba Health hospital discharge file and the Manitoba Health medical claims file, for capturing surgical procedures related to the treatment of breast cancer. The study cohort included all women diagnosed in Manitoba with invasive or in situ breast cancer between 1995 and 1999. The surgical procedures of interest were mastectomy, breast conserving surgery and axillary node dissection. Analysis focused on assessing concordance between data sources following record linkage. Agreement was measured using the kappa statistic, and chart reviews of discordant information were completed to identify the more reliable data source and to validate data files. The effect of using each data set alone to calculate procedure rates was determined to identify any clinically important differences arising from the choice of data source. Results indicate that capture of breast cancer patients using administrative data sets alone can be quite good and that the population-based cancer registry is superior to other administrative data sets for capturing surgical treatment information on cancer cases.