title: Increasing rates of surgical treatment and preventing comorbidities may increase breast cancer survival for Aboriginal women.
abstract: BACKGROUND
  Lower breast cancer survival has been reported for Australian Aboriginal women compared to non-Aboriginal women, however the reasons for this disparity have not been fully explored. We compared the surgical treatment and survival of Aboriginal and non-Aboriginal women diagnosed with breast cancer in New South Wales (NSW), Australia.
  
  
  METHODS
  We analysed NSW cancer registry records of breast cancers diagnosed in 2001-2007, linked to hospital inpatient episodes and deaths. We used unconditional logistic regression to compare the odds of Aboriginal and non-Aboriginal women receiving surgical treatment. Breast cancer-specific survival was examined using cumulative mortality curves and Cox proportional hazards regression models.
  
  
  RESULTS
  Of the 27 850 eligible women, 288 (1.03%) identified as Aboriginal. The Aboriginal women were younger and more likely to have advanced spread of disease when diagnosed than non-Aboriginal women. Aboriginal women were less likely than non-Aboriginal women to receive surgical treatment (odds ratio 0.59, 95% confidence interval (CI) 0.42-0.86). The five-year crude breast cancer-specific mortality was 6.1% higher for Aboriginal women (17.7%, 95% CI 12.9-23.2) compared with non-Aboriginal women (11.6%, 95% CI 11.2-12.0). After accounting for differences in age at diagnosis, year of diagnosis, spread of disease and surgical treatment received the risk of death from breast cancer was 39% higher in Aboriginal women (HR 1.39, 95% CI 1.01-1.86). Finally after also accounting for differences in comorbidities, socioeconomic disadvantage and place of residence the hazard ratio was reduced to 1.30 (95% CI 0.94-1.75).
  
  
  CONCLUSIONS
  Preventing comorbidities and increasing rates of surgical treatment may increase breast cancer survival for NSW Aboriginal women.
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, Australia. rajahs@nswcc.org.au.
authors.forename: Rajah
authors.initials: R
authors.lastname: Supramaniam
authors.forename: Alison
authors.initials: A
authors.lastname: Gibberd
authors.forename: Anthony
authors.initials: A
authors.lastname: Dillon
authors.forename: David Eamon
authors.initials: DE
authors.lastname: Goldsbury
authors.forename: Dianne L
authors.initials: DL
authors.lastname: O'Connell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000517:prevention & control / Q000601:surgery; D015897:Comorbidity; D005260:Female; D006801:Humans; D008875:Middle Aged; D009026:Mortality; D009517:New South Wales; D016017:Odds Ratio; D011159:Population Surveillance; D012042:Registries; D012307:Risk Factors; D055815:Young Adult