title: A cohort study of ethnic differences in use of adjuvant chemotherapy and radiation therapy for breast cancer in New Zealand.
abstract: Ethnic and socioeconomic inequities in use of breast cancer adjuvant therapy are well documented in many countries including the USA, and are known to contribute to lower breast cancer survival among minority ethnic and socioeconomically deprived women. We investigated ethnic and socioeconomic inequities in use of adjuvant radiotherapy and chemotherapy in a cohort of women with invasive breast cancer in New Zealand.
  
  
  
  All women with newly diagnosed invasive breast cancer during 1999-2012 were identified from the Waikato Breast Cancer Register. Rates of chemotherapy use and radiotherapy use were assessed in women who were deemed to be eligible for chemotherapy (n = 1212) and radiotherapy (n = 1708) based on guidelines. Factors associated with use of chemotherapy and radiation therapy were analysed in univariate and multivariate regression models, adjusting for covariates.
  
  
  
  Overall, rates of chemotherapy and radiotherapy use were 69% (n = 836) and 87.3% (n = 1491), respectively. In the multivariate model, significantly lower rates of radiotherapy use were associated with Māori compared with NZ European (Odds Ratio [OR] = 0.63, 0.40-0.98), presence of comorbidity (OR = 0.49, 0.34-0.72), distance from hospital of over 100km (OR = 0.47, 0.23-0.96), mastectomy compared with breast conserving surgery (OR = 0.32, 0.17-0.56) and non-screen compared with screen detection (OR = 0.53, 0.35-0.79). No significant associations were observed between chemotherapy use and ethnic or socio-demographic factors.
  
  
  
  Improving access for radiotherapy, especially for women who are at a higher risk of not receiving optimum cancer therapy due to ethnicity, geography or socioeconomic status need to be recognized as a priority to reduce inequities in breast cancer care 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.
authors.forename: Ian
authors.initials: I
authors.lastname: Campbell
authors.affiliation: Māori Health Services, Waikato District Health Board, Hamilton, New Zealand.
authors.forename: Nina
authors.initials: N
authors.lastname: Scott
authors.affiliation: Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
authors.forename: Ross
authors.initials: R
authors.lastname: Lawrenson
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000706:statistics & numerical data*; D015897:Comorbidity; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology / Q000208:ethnology; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*; D012306:Risk; D012923:Social Class
keywords: Breast cancer; Chemotherapy; Ethnicity; Inequity; Radiation therapy