title: Stage of breast cancer at diagnosis in New Zealand: impacts of socio-demographic factors, breast cancer screening and biology.
abstract: BACKGROUND
  Examination of factors associated with late stage diagnosis of breast cancer is useful to identify areas which are amenable to intervention. This study analyses trends in cancer stage at diagnosis and impact of socio-demographic, cancer biological and screening characteristics on cancer stage in a population-based series of women with invasive breast cancer in New Zealand.
  
  
  METHODS
  All women diagnosed with invasive breast cancer between 2000 and 2013 were identified from two regional breast cancer registries. Factors associated with advanced (stages III and IV) and metastatic (stage IV) cancer at diagnosis were analysed in univariate and multivariate models adjusting for covariates.
  
  
  RESULTS
  Of the 12390 women included in this study 2448 (19.7%) were advanced and 575 (4.6%) were metastatic at diagnosis. Māori (OR = 1.86, 1.39-2.49) and Pacific (OR = 2.81, 2.03-3.87) compared with NZ European ethnicity, other urban (OR = 2.00, 1.37-2.92) compared with main urban residency and non-screen (OR = 6.03, 4.41-8.24) compared with screen detection were significantly associated with metastatic cancer at diagnosis in multivariate analysis. A steady increase in the rate of metastatic cancer was seen which has increased from 3.8% during 2000-2003 to 5.0% during 2010-2013 period (p = 0.042).
  
  
  CONCLUSIONS
  Providing equitable high quality primary care and increasing mammographic screening coverage needs to be looked at as possible avenues to reduce late-stage cancer at diagnosis and to reduce ethnic, socioeconomic and geographical disparities in stage of breast cancer at diagnosis in New Zealand.
authors.affiliation: Waikato Clinical School, University of Auckland, Hamilton, New Zealand. sanjeewa_sa@yahoo.com.|Department of Surgery, University of Colombo, Colombo, Sri Lanka. sanjeewa_sa@yahoo.com.
authors.forename: Sanjeewa
authors.initials: S
authors.lastname: Seneviratne
authors.affiliation: Waikato Clinical School, University of Auckland, Hamilton, New Zealand. Ross.Lawrenson@waikatodhb.health.nz.
authors.forename: Ross
authors.initials: R
authors.lastname: Lawrenson
authors.affiliation: Auckland District Health Board, Auckland, New Zealand. vernonh@adhb.govt.nz.
authors.forename: Vernon
authors.initials: V
authors.lastname: Harvey
authors.affiliation: Auckland District Health Board, Auckland, New Zealand. reenarams53@gmail.com.
authors.forename: Reena
authors.initials: R
authors.lastname: Ramsaroop
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand. mark.elwood@auckland.ac.nz.
authors.forename: Mark
authors.initials: M
authors.lastname: Elwood
authors.affiliation: Māori Health Services, Waikato District Health Board, Hamilton, New Zealand. Nina.Scott@waikatodhb.health.nz.
authors.forename: Nina
authors.initials: N
authors.lastname: Scott
authors.affiliation: University of Otago, Wellington, New Zealand. diana.sarfati@otago.ac.nz.
authors.forename: Diana
authors.initials: D
authors.lastname: Sarfati
authors.affiliation: Waikato Clinical School, University of Auckland, Hamilton, New Zealand. Ian.Campbell@waikatodhb.health.nz.
authors.forename: Ian
authors.initials: I
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000473:pathology; D003710:Demography; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009520:New Zealand / Q000208:ethnology; D012042:Registries; D012959:Socioeconomic Factors; D055815:Young Adult