title: Geographical Inequalities in Surgical Treatment for Localized Female Breast Cancer, Queensland, Australia 1997-2011: Improvements over Time but Inequalities Remain.
abstract: The uptake of breast conserving surgery (BCS) for early stage breast cancer varies by where women live. We investigate whether these geographical patterns have changed over time using population-based data linkage between cancer registry records and hospital inpatient episodes. The study cohort consisted of 11,631 women aged 20 years and over diagnosed with a single primary invasive localised breast cancer between 1997 and 2011 in Queensland, Australia who underwent either BCS (n = 9223, 79%) or mastectomy (n = 2408, 21%). After adjustment for socio-demographic and clinical factors, compared to women living in very high accessibility areas, women in high (Odds Ratio (OR) 0.58 (95% confidence intervals (CI) 0.49, 0.69)), low (OR 0.47 (0.41, 0.54)) and very low (OR 0.44 (0.34, 0.56)) accessibility areas had lower odds of having BCS, while  the odds for women from middle (OR 0.81 (0.69, 0.94)) and most disadvantaged (OR 0.87 (0.71, 0.98)) areas was significantly lower than women living in affluent areas. The association between accessibility and the type of surgery reduced over time (interaction p = 0.028) but not for area disadvantage (interaction p = 0.209). In making informed decisions about surgical treatment, it is crucial that any geographical-related barriers to implementing their preferred treatment are minimised.
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia. peterbaade@cancerqld.org.au.|School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia. peterbaade@cancerqld.org.au.|Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia. peterbaade@cancerqld.org.au.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Baade
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia. paramitadasgupta@cancerqld.org.au.
authors.forename: Paramita
authors.initials: P
authors.lastname: Dasgupta
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia. pipyoul@cancerqld.org.au.|Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia. pipyoul@cancerqld.org.au.|School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia. pipyoul@cancerqld.org.au.
authors.forename: Philippa H
authors.initials: PH
authors.lastname: Youl
authors.affiliation: Mater Medical Centre, 293 Vulture Street, South Brisbane, QLD 4101, Australia. c_pyke@mc.mater.org.au.
authors.forename: Christopher
authors.initials: C
authors.lastname: Pyke
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia. joanneaitken@cancerqld.org.au.|Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia. joanneaitken@cancerqld.org.au.|School of Population Health, University of Queensland, Brisbane 4006, Australia. joanneaitken@cancerqld.org.au.|Institute for Resilient Regions, University of Southern Queensland, Toowoomba 4350, Australia. joanneaitken@cancerqld.org.au.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Aitken
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001943:Breast Neoplasms / Q000601:surgery*; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D016017:Odds Ratio; D011793:Queensland; D012959:Socioeconomic Factors; D035862:Vulnerable Populations
keywords: breast cancer; breast conserving surgery; geography; inequalities; mastectomy; socioeconomic