title: [Patterns of health care delivery and breast cancer in the department of Isère in 1955].
abstract: BACKGROUND
  Caring for cancer patients is expensive, warranting verification that health care organization works in a satisfactory way. A first step of this evaluation deals with the description of the pathway followed in the health care system by the patient.
  
  
  METHODS
  671 breast cancer cases were diagnosed in Isère in 1995. According to the place where each treatment (surgery, chemotherapy, radiotherapy) was performed, we described pathways for the patient, either entirely private, public or mixed. Characteristics of the patient (age, place of residence), of the disease (extent of disease, way of discovery) and of the physician (general practitioner, specialist) might have influenced the choice of this pathway. We described and tested the distribution of these characteristics within the 3 groups using univariate analysis. Relative risk of being affected to the private pathway compared to the public one was computed, after adjusting for age, type of physician, extent of disease, way of discovery and sanitary area, using a multivariate analysis (logistic regression).
  
  
  RESULTS
  In the department of Isère, the private pathway cared for 55% of breast cancers, the public one 23% and the mixed one 19%. There was no preferential recruitment according to age, physician type, presence of metastasis or of the rural or urban residence. In sanitary area number 5, characterized by an important attraction of the patients by the nearby department of Rhône, 41% of the patients were cared for the private pathway, compared to 63% in sanitary area 4, where most patients were treated in the main town of Isère: Grenoble. After early breast cancer detection with mammography instead of breast cancer screening, probability of being cared for in the private pathway was 2-fold higher (OR = 2) than in the public one.
  
  
  CONCLUSIONS
  In Isère department, early breast cancer detection with mammography is in favor of the private pathway. This is not true for physician type, neither for characteristics of the patient or extent of the disease. Finally, the distance to next department of oncology or radiotherapy plays a major role.
authors.affiliation: Registre du cancer de l'Isère, Meylan.
authors.forename: F
authors.initials: F
authors.lastname: Ménégoz
authors.forename: C
authors.initials: C
authors.lastname: Exbrayat
authors.forename: M
authors.initials: M
authors.lastname: Sousbie
authors.forename: C
authors.initials: C
authors.lastname: Laforêt
authors.forename: M
authors.initials: M
authors.lastname: Colonna
authors.forename: M F
authors.initials: MF
authors.lastname: Veran-Peyret
authors.forename: R
authors.initials: R
authors.lastname: Schaerer
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D019091:Critical Pathways; D003695:Delivery of Health Care; D005260:Female; D005602:France; D006801:Humans; D016015:Logistic Models; D008327:Mammography; D008875:Middle Aged; D015999:Multivariate Analysis; D017149:Private Sector; D012042:Registries; D012306:Risk
vernacular_title: Filières de soins et cancer du sein dans le département de l'Isère en 1995.