Female breast cancer in New South Wales, Australia, by country of birth: implications for health-service delivery

Abstract

Background NSW has a multicultural population with increasing migration from South East Asia, the Western Pacific and Eastern Mediterranean. Objective To compare cancer stage, treatment (first 12 months) and survival for 12 country of birth (COB) categories recorded on the population-based NSW Cancer Registry. Design Historic cohort study of invasive breast cancers diagnosed in 2003–2016. Patients Data for 48,909 women (18+ ages) analysed using linked cancer registry, hospital inpatient and Medicare and pharmaceutical benefits claims data. Measurement Comparisons by COB using multivariate logistic regression and proportional hazards regression with follow-up of vital status to April 30th, 2020. Results Compared with the Australia-born, women born in China, the Philippines, Vietnam and Lebanon were younger at diagnosis, whereas those from the United Kingdom, Germany, Italy and Greece were older. Women born in China, the Philippines, Vietnam, Greece and Italy lived in less advantaged areas. Adjusted analyses indicated that: (1) stage at diagnosis was less localised for women born in Germany, Greece, Italy and Lebanon; (2) a lower proportion reported comorbidity for those born in China, the Philippines and Vietnam; (3) surgery type varied, with mastectomy more likely for women born in China, the Philippines and Vietnam, and less likely for women born in Italy, Greece and Lebanon; (4) radiotherapy was more likely where breast conserving surgery was more common (Greece, Italy, and Lebanon) and the United Kingdom; and (5) systemic drug therapy was less common for women born in China and Germany. Five-year survival in NSW was high by international standards and increasing. Adjusted analyses indicate that, compared with the Australian born, survival from death from cancer at 5 years from diagnosis was higher for women born in China, the Philippines, Vietnam, Italy, the United Kingdom and Greece. Conclusions There is diversity by COB of stage, treatment and survival. Reasons for survival differences may include cultural factors and healthier migrant populations with lower comorbidity, and potentially, less complete death recording in Australia if some women return to their birth countries for treatment and end-of-life care. More research is needed to explore the cultural and clinical factors that health services need to accommodate.

Country of birth and non-small cell lung cancer incidence, treatment, and outcomes in New South Wales, Australia: a population-based linkage study

“…This is a population-based cohort study using linked cancer registry, treatment and death data. The analysis used linked diagnostic data for invasive NSCLC from the NSW Cancer Registry (NSWCR) [ 8 ], hospitalisation data from the Admitted Patient Data Collection (APDC) and Emergency Department Data Collection (EDDC), claims to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), and death-record data from the National Death Index (NDI) [ 8 ]. The health care system in New South Wales operates under a public model, with universal taxpayer-funded access to cancer diagnostic and treatment services available to all Australian citizen and permanent residents.…”

“…Data on types of treatment received (surgery, radiotherapy, and systemic therapy respectively) during the 12 months from diagnosis (including neoadjuvant therapies), included fact of surgery identified using APDC data; fact of radiotherapy using a combination of APDC and MBS data; and fact of systemic therapy from a combination of APDC, MBS and PBS data (Additional file 1 : Table S1) [ 8 ].…”

“…Covariates included in multivariable models included sex, age at diagnosis, calendar year of diagnosis, Charlson comorbidity score, and socioeconomic status [ 8 , 14 ].…”

“…These countries represent the ten countries of birth with the highest lung cancer incidence during the study period. All other countries were grouped into “other English-speaking” or “other non-English speaking” categories [ 8 ].…”

Closed Incision Negative Pressure Therapy vs Standard of Care Dressing in Breast Surgery: A Systematic Review

“…An estimated 20,000 new cases were diagnosed in 2021 [ 1 ]. Around 38% of patients with breast cancer will end up having a mastectomy [ 2 ]. Despite the volume of breast surgery performed each year and the modernisation of sterilisation methods, equipment, and surgical technique, post-operative wound complications from breast surgery still occur in the range of 1 to 30% [ 3 ].…”