title: Risk factors for poorer breast cancer outcomes in residents of remote areas of Australia.
abstract: To investigate patient, cancer and treatment characteristics in females with breast cancer from more remote areas of Australia, to better understand reasons for their poorer outcomes, bi-variable and multivariable analyses were undertaken using the National Breast Cancer Audit database of the Society of Breast Surgeons of Australia and New Zealand. Results indicated that patients from more remote areas were more likely to be of lower socio- economic status and be treated in earlier diagnostic epochs and at inner regional and remote rather than major city centres. They were also more likely to be treated by low case load surgeons, although this finding was only of marginal statistical significance in multivariable analysis (p=0.074). Patients from more remote areas were less likely than those from major cities to be treated by breast conserving surgery, as opposed to mastectomy, and less likely to have adjuvant radiotherapy when having breast conserving surgery. They had a higher rate of adjuvant chemotherapy. Further monitoring will be important to determine whether breast conserving surgery and adjuvant radiotherapy utilization increase in rural patients following the introduction of regional cancer centres recently funded to improve service access in these areas.
authors.affiliation: Cancer Australia, Sydney, Australia. roder@internode.on.net
authors.forename: David
authors.initials: D
authors.lastname: Roder
authors.forename: Helen
authors.initials: H
authors.lastname: Zorbas
authors.forename: James
authors.initials: J
authors.lastname: Kollias
authors.forename: Chris
authors.initials: C
authors.lastname: Pyke
authors.forename: David
authors.initials: D
authors.lastname: Walters
authors.forename: Ian
authors.initials: I
authors.lastname: Campbell
authors.forename: Corey
authors.initials: C
authors.lastname: Taylor
authors.forename: Fleur
authors.initials: F
authors.lastname: Webster
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001315:Australia; D001943:Breast Neoplasms / Q000175:diagnosis / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D012424:Rural Population; D012923:Social Class; D018709:Statistics, Nonparametric