title: Unequal access to breast-conserving surgery in Western Australia 1982-2000.
abstract: BACKGROUND
  The purpose of the present study was to examine the effects of demographic, locational and social disadvantage and the possession of private health insurance in Western Australia on the likelihood of women with breast cancer receiving breast-conserving surgery rather than mastectomy.
  
  
  METHODS
  The WA Record Linkage Project was used to extract all hospital morbidity, cancer and death records of women with breast cancer in Western Australia from 1982 to 2000 inclusive. Comparisons between those receiving breast-conserving surgery and mastectomy were made after adjustment for covariates in logistic regression.
  
  
  RESULTS
  Younger women, especially those aged less than 60 years, and those with less comorbidity were more likely to receive breast-conserving surgery (BCS). In lower socio-economic groups, women were less likely to receive BCS (OR 0.73; 95% CI 0.60-0.90). Women resident in rural areas tended to receive less BCS than those from metropolitan areas (OR 0.84; 95% CI 0.55-1.29). Women treated in a rural hospital had a reduced likelihood of BCS (OR 0.74; 95% CI 0.61-0.89). Treatment in a private hospital reduced the likelihood of BCS (OR 0.70; 95% CI 0.54-0.90), while women with private health insurance were much more likely to receive BCS (OR 1.39; 95% CI 1.08-1.79).
  
  
  CONCLUSIONS
  Several factors were found to affect the likelihood of women with breast cancer receiving breast-conserving surgery, in particular, women from disadvantaged backgrounds were significantly less likely to receive breast-conserving surgery than those from more privileged groups.
authors.affiliation: School of Population Health, University of Western Australia, Crawley, Western Australia, Australia. shall@sph.uwa.edu.au
authors.forename: Sonĵa E
authors.initials: SE
authors.lastname: Hall
authors.forename: C D J
authors.initials: CD
authors.lastname: Holman
authors.forename: Delia V
authors.initials: DV
authors.lastname: Hendrie
authors.forename: Katrina
authors.initials: K
authors.lastname: Spilsbury
mesh_terms: D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008507:Medically Underserved Area; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D011287:Prejudice; D012935:Social Justice; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D014904:Western Australia