Breast cancer diagnosis, patterns of care and burden of disease in Queensland, Australia (1998–2004): does being Indigenous make a difference?
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We compared patterns of care, comorbidity, disability-adjusted life-years (DALYs) and survival in Indigenous and non-Indigenous women with breast cancer in Queensland, Australia (1998–2004).
A cohort study of Indigenous (n = 110) and non-Indigenous women (n = 105), frequency matched on age and remoteness. We used Pearson’s Chi-squared analysis to compare proportions, hazard models to assess survival differences and calculated disability-adjusted life years (DALYs).
Indigenous women were more likely to be socially disadvantaged (43 vs. 20 %, p < 0.01) have comorbidity (42 vs. 18 % p < 0.01), and have regional spread or distant metastasis (metastasis, 51 vs. 36 %, p = 0.02) than non-Indigenous women; there was no difference in treatment patterns. More Indigenous women died in the follow-up period (p = 0.01). DALY’s were 469 and 665 per 100,000 for Indigenous and non-Indigenous women, respectively, with a larger proportion of the burden attributed to premature death among the former (63 vs. 59 %).
Indigenous women with breast cancer received comparable treatment to their non-Indigenous counterparts. The higher proportion of DALYs related to early death in Indigenous women suggests higher fatality with breast cancer in this group. Later stage at diagnosis and higher comorbidity presence among Indigenous women reinforce the need for early detection and improved management of co-existing disease.
KeywordsIndigenous Breast cancer Comorbidities Cancer stage Treatment Disability-adjusted life years
S. Moore was supported by a National Health and Medical Research Council (NHMRC) Training Scholarship for Indigenous Australian Health Research (No. 389935) and a Postdoctoral Fellowship from the International Agency for Research on Cancer/Cancer Australia. The NHMRC Project Grant (No. 1004643) partly funded this project. S Moore and P Valery were also supported by the former Australian Centre for International and Tropical Health, UQ. PC Valery was supported by an Australian Research Council Future Fellowship (No. 100100511). This work was produced as part of the In-Kind activities of the Lowitja Institute incorporating the Cooperative Research Centre for Aboriginal and Torres Strait Islander Health. The authors declare that they have no competing interests.
Compliance with ethical standards
SP Moore participated in the conception, design, analyses of the data, interpretation of results, writing and editing the manuscript. I Soerjomataram conducted analysis of DALYS, interpretation of results, and editing of the manuscript. A Green participated in the conception, design, analyses of the data, interpretation of results and editing the manuscript. G Garvey participated in the interpretation of results and editing the manuscript. J Martin participated in the interpretation of results and editing the manuscript. P Valery participated in the conception, design, analyses of the data, interpretation of results and editing the manuscript. We confirm that all authors have seen and approved its final version.
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