Ethnic differences in breast cancer survival in New Zealand: contributions of differences in screening, treatment, tumor biology, demographics and comorbidities

Seneviratne, Sanjeewa; Campbell, Ian; Scott, Nina; Shirley, Rachel; Peni, Tamati; Lawrenson, Ross

doi:10.1007/s10552-015-0674-5

Cited by 25 publications

(47 citation statements)

References 36 publications

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“…In New Zealand, differences have been shown in the presentation and outcomes of breast cancer for Māori and Pacific women compared with NZ Europeans [6,7]. A prior study using NZ cancer registry data did not show differences in breast cancer mortality or stage of diagnosis for urban versus rural women after adjustment for age, ethnicity and socioeconomic status [8].…”

Section: Introductionmentioning

confidence: 99%

Urban Rural Differences in Breast Cancer in New Zealand

Lawrenson

Lao

Elwood

et al. 2016

IJERPH

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Many rural communities have poor access to health services due to a combination of distance from specialist services and a relative shortage of general practitioners. Our aims were to compare the characteristics of urban and rural women with breast cancer in New Zealand, to assess breast cancer-specific and all-cause survival using the Kaplan–Meier method and Cox proportional hazards model, and to assess whether the impact of rurality is different for Māori and New Zealand (NZ) European women. We found that rural women tended to be older and were more likely to be Māori. Overall there were no differences between urban and rural women with regards their survival. Rural Māori tended to be older, more likely to be diagnosed with metastatic disease and less likely to be screen detected than urban Māori. Rural Māori women had inferior breast cancer-specific survival and all-cause survival at 10 years at 72.1% and 55.8% compared to 77.9% and 64.9% for urban Māori. The study shows that rather than being concerned that more needs to be done for rural women in general it is rural Māori women where we need to make extra efforts to ensure early stage at diagnosis and optimum treatment.

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Section: Introductionmentioning

confidence: 99%

Urban Rural Differences in Breast Cancer in New Zealand

Lawrenson

Lao

Elwood

et al. 2016

IJERPH

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“…Our own work using the NZ Waikato Breast Cancer Register has showed that Māori women are diagnosed with more advanced disease, with 11% of Māori versus 4.6% of NZ European women having Stage IV disease at diagnosis (Seneviratne et al . ). This disparity was confirmed in a larger study of 12 385 women combining two NZ‐based breast cancer registers from Auckland and Waikato.…”

Section: Stage and Characteristics At Diagnosismentioning

confidence: 97%

“…In a study using a detailed clinical cancer registry including 2679 women with breast cancer, we found that compared to non‐Māori women, Māori women had a significantly higher age‐adjusted cancer‐specific mortality (HR 2.02, 95% CI 1.59–2.58) with significantly lower 5‐year (86.8% vs. 76.1%) and 10‐year (79.9% vs. 66.9%) crude cancer‐specific survivals (Seneviratne et al . ). Using the detailed data available on cancer biology, treatment and stage at diagnosis, we were able to explain almost all of the variation in mortality.…”

Section: Treatment and Survival Differencesmentioning

confidence: 97%

“…Tumour biology made a small but significant difference, while treatment differences also made a contribution (Seneviratne et al . ).…”

Section: Treatment and Survival Differencesmentioning

confidence: 97%

“…The reason for these differences have been suggested as being multi‐factorial including differences in screening coverage, differences in cancer biology and differences in treatment (Seneviratne et al . ,d).…”

Section: Treatment and Survival Differencesmentioning

confidence: 99%

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Breast cancer inequities between Māori and non-Māori women in Aotearoa/New Zealand

et al. 2016

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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.

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Ethnic Disparities for Survival and Mortality in New Zealand Patients With Head and Neck Cancer

Weaver,

Twine,

Bather

et al. 2024

JAMA Netw Open

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ImportanceIt is essential to identify inequitable cancer care for ethnic minority groups, which may allow policy change associated with improved survival and decreased mortality and morbidity.ObjectiveTo investigate ethnic disparities in survival and mortality among New Zealand (NZ) patients with head and neck cancer (HNC) and the association of other variables, including socioeconomic status, tumor stage, and age at diagnosis, with survival rates.Design, Setting, and ParticipantsThis retrospective cohort study was conducted among NZ patients diagnosed with specific HNCs from 2010 to 2020. Anonymized data were obtained from the NZ Cancer Registry, including patients diagnosed from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes C00-C14 and C30-C32. Data were analyzed from July 2020 through January 2024.Main Outcomes and MeasuresCensored Kaplan-Meier estimates were used to analyze survival distribution. Cox regression models were used to estimate the association of age, tumor stage at diagnosis, and socioeconomic status with survival rates. Age-standardized mortality rates were assessed.ResultsAmong 6593 patients with HNCs (4590 males [69.6%]; 4187 patients aged 51-75 years [63.5%]), there were 706 Māori individuals (10.7%) and 5887 individuals with other ethnicity (89.3%), including 4327 NZ European individuals (65.6%; defined as New Zealanders of European descent). Māori individuals had a decreased survival proportion at all years after diagnosis compared with individuals with other ethnicity (eg, 66.1% [95% CI, 62.6%% to 69.8%] vs 71.2% [95% CI, 70.0% to 72.4%] at 2 years). At 1 year after diagnosis, Māori individuals did not have a significantly increased mortality rate compared with 5795 individuals with other ethnicity with data (193 deaths [27.3%] vs 1400 deaths [24.2%]; P = .06), but the rate was significantly increased at 5 years after diagnosis (277 deaths [39.3%] vs 2034 deaths [35.1%]; P = .03); there was greater disparity compared with NZ European individuals (1 year: 969 deaths [22.4%]; P = .003; 5 years: 1441 deaths [33.3%]; P = .002). There were persistent age-adjusted mortality rate disparities: 40.1% (95% CI, −25.9% to 71.2%) for Māori individuals and 18.8% (95% CI, −15.4% to 24.4%) for individuals with other ethnicity. Māori individuals were diagnosed at a mean age of 58.0 years (95% CI, 57.1-59.1 years) vs 64.3 years. (95% CI, 64.0-64.7 years) for individuals with other ethnicity, or 5 to 7 years younger, and died at mean age of 63.5 years (95% CI, 62.0-64.9 years) compared with 72.3 years (95% CI, 71.8-72.9 years) for individuals with other ethnicity, or 7 to 10 years earlier. Māori individuals presented with proportionally more advanced disease (only localized disease, 102 patients [14.5%; 95% CI, 12.0%-17.4%] vs 1413 patients [24.0%; 95% CI, 22.9%-25.1%]; P &lt; .001) and showed an increase in regional lymph nodes (276 patients [39.1%; 95% CI, 35.5%-42.9%] vs 1796 patients [30.5%; 95% CI, 29.3%-31.8%]; P &lt; .001) at diagnosis compared with individuals with other ethnicity. Socioeconomic status was not associated with survival.Conclusions and RelevanceThis study found that Māori individuals experienced worse survival outcomes and greater mortality rates from HNC in NZ and presented with more advanced disease at a younger age. These findings suggest the need for further research to alleviate these disparities, highlight the importance of research into minority populations with HNC globally, and may encourage equity research for all cancers.

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Ethnic differences in breast cancer survival in New Zealand: contributions of differences in screening, treatment, tumor biology, demographics and comorbidities

Cited by 25 publications

References 36 publications

Urban Rural Differences in Breast Cancer in New Zealand

Urban Rural Differences in Breast Cancer in New Zealand

Breast cancer inequities between Māori and non-Māori women in Aotearoa/New Zealand

Ethnic Disparities for Survival and Mortality in New Zealand Patients With Head and Neck Cancer

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