Ethnicity and the surgical management of early invasive breast cancer in over 164 000 women.

BACKGROUND: Limited information is available about patterns of surgical management of early breast cancer by ethnicity of women in England, and any potential inequalities in the treatment received for breast cancer. METHODS: National Cancer Registration and Analysis Service data for women diagnosed with early invasive breast cancer (ICD-10 C50) during 2012-2017 were analysed. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95 per cent confidence intervals for the risk of mastectomy versus breast-conserving surgery by ethnicity (black African, black Caribbean, Indian, Pakistani and white), adjusting for age, region, deprivation, year of diagnosis, co-morbidity and stage at diagnosis. RESULTS: Data from 164 143 women were included in the analysis. The proportion of women undergoing mastectomy fell by approximately 5 per cent between 2012 and 2017 across all the ethnic groups examined. In unadjusted analyses, each ethnic minority group had a significantly higher odds of mastectomy than white women; however, in the fully adjusted model, there were no significantly increased odds of having mastectomy for women of any ethnic minority group examined. For example, compared with white women, the unadjusted and fully adjusted ORs for mastectomy were 1·14 (95 per cent c.i. 1·05 to 1·20) and 1·04 (0·96 to 1·14) respectively for Indian women, and 1·45 (1·30 to 1·62) and 1·00 (0·89 to 1·13) for black African women. This attenuation in OR by ethnicity was largely due to adjustment for age and stage. CONCLUSION: Allowing for different patterns of age and stage at presentation, the surgical management of early breast cancer is similar in all women, regardless of ethnicity.

Disability and participation in breast and bowel cancer screening in England: a large prospective study.

BACKGROUND: There is limited information about participation in organised population-wide screening programmes by people with disabilities. METHODS: Data from the National Health Service routine screening programmes in England were linked to information on disability reported by the Million Women Study cohort participants. RESULTS: Of the 473 185 women offered routine breast or bowel cancer screening, 23% reported some disability. Women with disabilities were less likely than other women to participate in breast cancer screening (RR=0.64, 95% CI: 0.62-0.65) and in bowel cancer screening (RR=0.75, 0.73-0.76). Difficulties with self-care or vision were associated with the greatest reduction in screening participation. CONCLUSION: Participation in routine cancer screening programmes in England is reduced in people with disabilities and participation varies by type of disability.

Ethnic differences in breast cancer incidence in England are due to differences in known risk factors for the disease: prospective study.

BACKGROUND: In the United Kingdom, breast cancer incidence is lower in South Asian and Black women than in White women, but the extent to which this is due to known risk factors is unknown. In a large prospective study, we describe breast cancer incidence by ethnicity, before and after adjustment for known risk factors for the disease. METHODS: Women were recruited into the Million Women Study in 1996-2001, when information on reproductive and lifestyle factors known to influence the risk of breast cancer was obtained. Ethnicity was determined from study questionnaires and hospital admission data. Cox regression models were used to calculate adjusted relative risks (RR) for incident breast cancer in South Asians and Blacks compared with Whites. RESULTS: Analyses included 5877 South Asian, 4919 Black, and 1,038,144 White women in England. The prevalence of 8 out of the 9 risk factors for breast cancer examined, differed substantially by ethnicity (P<0.001 for each), such that South Asian and Black women were at a lower risk of the disease than White women. During 12.2 years of follow-up incident breast cancer occurred in 217 South Asians, 180 Blacks, and 45,191 Whites. As expected, breast cancer incidence was lower in South Asians (RR=0.82, 95% CI 0.72-0.94) and Blacks (RR=0.85, 0.73-0.98) than in Whites when the analyses were adjusted only for age and region of residence. However, after additional adjustment for the known risk factors for the disease, breast cancer incidence was similar to that of Whites, both in South Asians (0.95, 0.83-1.09) and in Blacks (0.91, 0.78-1.05). CONCLUSION: South Asian and Black women in England have lower incidence rates of breast cancer than White women, but this is largely, if not wholly, because of differences in known risk factors for the disease.

Pathology reports provided reliable and readily accessible records of surgical procedures performed in women with breast cancer.

OBJECTIVE: Extracting complete and accurate records of surgical procedures from case-notes is time consuming and laborious. We compared the completeness and time taken to extract data on surgical procedures from case-notes and from pathology reports. STUDY DESIGN AND SETTING: Information on surgical procedures was extracted from pathology reports and hospital case-notes for 111 women with breast cancer in three centers. The time taken to perform this task was recorded. Surgical procedures were classified into diagnostic and therapeutic procedures, and analysis was performed to determine the completeness and accuracy of the documentation of the procedures. RESULTS: The average time taken to extract relevant information from the pathology reports (3.0 minutes) was one-fifth that for the case-notes (14.4 minutes). The case-notes documented slightly fewer procedures than the pathology records: 94 vs. 108 diagnostic and 108 vs. 110 therapeutic procedures, respectively. Of the 219 therapeutic and diagnostic surgical procedures recorded by both data sources, for 216 procedures there was exact agreement as to the specific type of procedure performed. CONCLUSIONS: Extraction of information on surgical procedures is faster from pathology records than from case-notes. The level of agreement for the specific type of procedure performed is excellent and, if anything, the pathology records are more complete than the case-notes.