title: Breast cancer inequities between Māori and non-Māori women in Aotearoa/New Zealand.
abstract: Māori women have one of the highest incidences of breast cancer in the world. This high incidence is generally unexplained although higher rates of obesity and alcohol intake are modifiable risk factors that may be important. Māori women are less likely to attend mammographic breast screening and are likely to be diagnosed with more advanced disease. This is one of the reasons for the excess mortality. Another factor is differences in the treatment pathway. Māori women are more likely to experience delay in receiving treatment, are less likely to receive radiotherapy, are more likely to be treated with a mastectomy and are less likely to adhere to long-term adjuvant endocrine therapy. However, genetic factors in Māori women do not seem to impact significantly on mortality. This review looks at the inequity between Māori and non-Māori women and addresses the causes. It proposes ways of reducing inequity through primary prevention, increased participation in breast screening and greater standardisation of the treatment pathway for women newly diagnosed with breast cancer. We believe that health system improvements will decrease barriers to health care participation for Māori women and suggest that further research into identifying and modifying obstacles within health systems is required.
authors.affiliation: Waikato Clinical Campus, The University of Auckland, Hamilton, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Lawrenson
authors.affiliation: Department of Surgery, Faculty of Medicine, National Hospital of Sri Lanka, University of Colombo, Colombo, Sri Lanka.
authors.forename: S
authors.initials: S
authors.lastname: Seneviratne
authors.affiliation: Te Puna Oranga, Waikato District Health Board, Hamilton, New Zealand.
authors.forename: N
authors.initials: N
authors.lastname: Scott
authors.affiliation: Waikato Clinical Campus, The University of Auckland, Hamilton, New Zealand.
authors.forename: T
authors.initials: T
authors.lastname: Peni
authors.affiliation: Waikato Clinical Campus, The University of Auckland, Hamilton, New Zealand.
authors.forename: C
authors.initials: C
authors.lastname: Brown
authors.affiliation: Waikato Clinical Campus, The University of Auckland, Hamilton, New Zealand.
authors.forename: I
authors.initials: I
authors.lastname: Campbell
mesh_terms: D000428:Alcohol Drinking / Q000208:ethnology*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D057210:Delayed Diagnosis; D055088:Early Detection of Cancer; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000706:statistics & numerical data; D009520:New Zealand / Q000453:epidemiology; D009765:Obesity / Q000208:ethnology*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012307:Risk Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D044465:White People
chemical_list: D018931:Antineoplastic Agents, Hormonal
keywords: Maori; New Zealand; breast cancer; epidemiology; ethnicity; screening; treatment