Stage of breast cancer at diagnosis in New Zealand: impacts of socio-demographic factors, breast cancer screening and biology

Seneviratne, Sanjeewa; Lawrenson, Ross; Harvey, Vernon; Ramsaroop, Reena; Elwood, Mark; Scott, Nina; Sarfati, Diana; Campbell, Ian

doi:10.1186/s12885-016-2177-5

Cited by 50 publications

(54 citation statements)

References 34 publications

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“…This is in contrast with a study in South Africa where McCormack et al reported that late stage tumours were more likely to be estrogen and progesterone receptor negative, but noted no association with HER2 status. 38 In New Zealand, researchers have reported poorly differentiated tumour grade (II and III) in women with late stage disease, 16 similar to findings in the United States, by Lipscomb et al who found advanced stage breast cancer to be positively related with poorly differentiated tumour grade and HER2 type tumours. 14 Our sample size for this analysis was, however, very limited, and thus, the influence of tumour characteristics on stage at diagnosis still needs to be fully explored in the SSA setting.…”

Section: Discussionsupporting

confidence: 62%

Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors

Jedy‐Agba

McCormack

Olaomi

et al. 2017

Cancer Causes Control

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Purpose Advanced stage at diagnosis is a common feature of breast cancer in Sub-Saharan Africa (SSA), contributing to poor survival rates. Understanding its determinants is key to preventing deaths from this cancer in SSA. Methods Within the Nigerian Integrative Epidemiology of Breast Cancer Study (NIBBLE) multicentre case-control study on breast cancer, we studied factors affecting stage at diagnosis of cases, i.e. women diagnosed with histologically confirmed invasive breast cancer between January 2014 and July 2016 at six secondary and tertiary hospitals in Nigeria. Stage was assessed using clinical and imaging methods. Ordinal logistic regression was used to examine associations of socio-demographic, breast cancer awareness, health care access and clinical factors with odds of later stage (I, II, III or IV) at diagnosis. Results A total of 316 women were included, with a mean age (SD) of 45.4 (11.4) years. Of these, 94.9% had stage information: 5 (1.7%), 92 (30.7%), 157 (52.4%), and 46 (15.3%) were diagnosed at stages I, II, III and IV, respectively. In multivariate analyses, lower educational level (odds ratio (OR) 2.35, 95% confidence interval: 1.04, 5.29), not believing in a cure for breast cancer (1.81: 1.09, 3.01), and living in a rural area (2.18: 1.05, 4.51) were strongly associated with later stage, whilst age at diagnosis, tumour grade and oestrogen receptor status were not. Being Muslim (vs. Christian) was associated with lower odds of later stage disease (0.46: 0.22, 0.94). Conclusion Our findings suggest that factors that are amenable to intervention concerning breast cancer awareness and health care access, rather than intrinsic tumour characteristics, are the strongest determinants of stage at diagnosis in Nigerian women.

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Section: Discussionsupporting

confidence: 62%

Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors

Jedy‐Agba

McCormack

Olaomi

et al. 2017

Cancer Causes Control

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“…There is also variation in the definition of what is considered a rural population. This study is based on substantially more detailed clinical data available (including accurate staging, screening history and presence of biological markers) from two clinical breast cancer registers in the Waikato and Auckland regions [9]. Waikato District Health Board has a large rural community with 60% of patients living outside the main centre of Hamilton, while Auckland on the other hand is mainly an urban community.…”

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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“…This showed 3.9% of NZ European women had metastatic breast cancer at diagnosis compared with 7.6% of Māori women (adjusted OR 1.86 95% CI 1.39–2.49) (Seneviratne et al . in press).…”

Section: Stage and Characteristics At Diagnosismentioning

confidence: 99%

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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Stage of breast cancer at diagnosis in New Zealand: impacts of socio-demographic factors, breast cancer screening and biology

Cited by 50 publications

References 34 publications

Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors

Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors

Urban Rural Differences in Breast Cancer in New Zealand

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

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