title: Breast cancer diagnosis, patterns of care and burden of disease in Queensland, Australia (1998-2004): does being Indigenous make a difference?
abstract: OBJECTIVE
  We compared patterns of care, comorbidity, disability-adjusted life-years (DALYs) and survival in Indigenous and non-Indigenous women with breast cancer in Queensland, Australia (1998-2004).
  
  
  METHODS
  A cohort study of Indigenous (n = 110) and non-Indigenous women (n = 105), frequency matched on age and remoteness. We used Pearson's Chi-squared analysis to compare proportions, hazard models to assess survival differences and calculated disability-adjusted life years (DALYs).
  
  
  RESULTS
  Indigenous women were more likely to be socially disadvantaged (43 vs. 20 %, p < 0.01) have comorbidity (42 vs. 18 % p < 0.01), and have regional spread or distant metastasis (metastasis, 51 vs. 36 %, p = 0.02) than non-Indigenous women; there was no difference in treatment patterns. More Indigenous women died in the follow-up period (p = 0.01). DALY's were 469 and 665 per 100,000 for Indigenous and non-Indigenous women, respectively, with a larger proportion of the burden attributed to premature death among the former (63 vs. 59 %).
  
  
  CONCLUSIONS
  Indigenous women with breast cancer received comparable treatment to their non-Indigenous counterparts. The higher proportion of DALYs related to early death in Indigenous women suggests higher fatality with breast cancer in this group. Later stage at diagnosis and higher comorbidity presence among Indigenous women reinforce the need for early detection and improved management of co-existing disease.
authors.affiliation: Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia. suzanne.moore@menzies.edu.au.|Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France. suzanne.moore@menzies.edu.au.
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Moore
authors.affiliation: Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Soerjomataram
authors.affiliation: Cancer and Population Studies Group, QIMR Berghofer of Medical Research Institute, Brisbane, Queensland, Australia.|CRUK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Adèle C
authors.initials: AC
authors.lastname: Green
authors.affiliation: Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia.
authors.forename: Gail
authors.initials: G
authors.lastname: Garvey
authors.affiliation: School of Medicine, University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland, Australia.|School of Medicine, University of Newcastle, Callaghan, NSW, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Martin
authors.affiliation: Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia.|Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.|Cancer and Population Studies Group, QIMR Berghofer of Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Valery
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000208:ethnology; D016016:Proportional Hazards Models; D011793:Queensland; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Breast cancer; Cancer stage; Comorbidities; Disability-adjusted life years; Indigenous; Treatment