While breast cancer survival rates have improved on a national level, not all women have benefited equally, a systematic review has found
Women living outside of Australian cities have consistently worse breast cancer outcomes compared with their metropolitan counterparts, new research indicates.
Australian women are more likely to get breast cancer than any other cancer, and the condition is responsible for the second highest number of cancer deaths.
But while survival rates have improved on a national level, not all women have benefited equally, the authors of the first systematic review into a range of breast cancer outcomes for metropolitan and regional Australians say.
“There was a consistent pattern of significantly poorer survival (in unadjusted analyses) for women in non-metropolitan areas compared with metropolitan women,” the authors wrote.
This is important, given one in five women live outside major cities.
In all but one study, women in regional or remote areas had a 2 to 5% lower absolute five-year unadjusted relative survival rate compared with their metropolitan peers, the review of 74 quantitative studies found.
“There was good evidence that poorer breast cancer survival (at least up to five years after diagnosis) for non-metropolitan women reflects more-advanced disease at diagnosis, greater comorbidities, treatment-related factors and area-level disadvantage,” the authors said.
The research revealed that women in these areas were less likely to have optimal care for early breast cancer.
Women in regional Australia were at least five times more likely to have mastectomies, and rates of breast-conserving surgery decreased the more remote the women were.
In addition to the concerning finding that these women were less likely to get adjuvant radiotherapy, they were also less likely to have hormonal therapy, postmastectomy breast reconstruction and sentinel node biopsies, the authors said.
Socioeconomically disadvantaged women were 17 times more likely to live in remote areas compared with affluent women.
It wasn’t all bad news though. Screening rates appeared to be similar among those living in the country and the city-dwellers.
Half the studies found no difference in survival based on location if the authors factored in other known risk characteristics, such as comorbidities, demographics, disadvantage, spread of disease and other treatment-related factors.
The authors noted that despite the development of well-regarded Regional Cancer Centres and integrated cancer networks across the country, access was still spotty.
Ultimately, major questions remained about the health and treatment of women with breast cancer in Australia owing to the lack of coordination in tracking and studying outcomes and locations, the authors said.
BMJ Open 2018; online 29 April
