Geographical differences in risk of advanced breast cancer: Limited evidence for reductions over time,Queensland, Australia 1997–2014 |
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| Institution: | 1. Cancer Council Queensland, PO Box 201, Spring Hill, QLD 4004, Australia;2. University of the Sunshine Coast, Sippy Downs, QLD, 4556, Australia;3. School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD, 4059, Australia;4. School of Population Health, University of Queensland, Brisbane, Australia;5. Institute for Health and Ageing, Australian Catholic University, Melbourne, 3065, Victoria, Australia;6. Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, 4222, Australia;7. School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD, 4000, Australia;1. Laboratory of Clinical Molecular Biology, Department of Biochemistry & Clinical Biochemistry, Catholic University of the Sacred Heart, Rome, Italy;2. Laboratory Medicine Department, San Camillo Hospital, Treviso, Italy;3. Gynecology Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy;1. Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;2. Division of Urologic Surgery, Brigham and Women׳s Hospital, Boston, MA, USA;3. Department of Medicine, Gastroenterology, Brigham and Women׳s Hospital, Boston, MA, USA;4. Department of Surgery, Gastrointestinal and General Surgery, Brigham and Women׳s Hospital, Boston, MA, USA;5. Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA;6. Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA;1. Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL;2. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL;3. Department of Geography and Geographic Information Science, University of Illinois Urbana-Champaign, Urbana, IL;1. Public Health Wales, Screening Division, Cervical Screening Wales, 18 Cathedral Road, Cardiff CF11 9LJ, Wales, UK;2. School of Medicine, Cardiff University, Cardiff CF14 4XN, Wales, UK;3. Health Information Research Unit, Swansea University, College of Medicine, Swansea SA2 8PP, Wales, UK;4. Cancer Research UK Health Behaviour Research Centre, Research Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK;5. Centre for Improvement in Population Health through E-records Research, Swansea University, College of Medicine, Swansea SA2 8PP, Wales, UK;1. University of St. Thomas, Department of Health and Exercise Science, 2115 Summit Ave S., Mail #4004, St. Paul, MN 55105-1078, USA;2. South Dakota State University, Pharmacy & Allied Health Professions, SAV 149, Box 2202C, Brookings, SD 57007, USA;3. Vision Church, 3270 19th St NW #208, 55901, Rochester, MN, USA;4. Mayo Clinic, 200 First Street SW Rochester, 55905, Rochester, MN, USA |
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| Abstract: | BackgroundReducing geographical inequalities in breast cancer stage remains a key focus of public health policy. We explored whether patterns of advanced breast cancer by residential accessibility and disadvantage in Queensland, Australia, have changed over time.MethodsPopulation-based cancer registry study of 38,706 women aged at least 30 years diagnosed with a first primary invasive breast cancer of known stage between 1997 and 2014. Multilevel logistic regression was used to examine temporal changes in associations of area-level factors with odds of advanced disease after adjustment for individual-level factors.ResultsOverall 19,401 (50%) women had advanced breast cancer. Women from the most disadvantaged areas had higher adjusted odds (OR = 1.23 95%CI 1.13, 1.32]) of advanced disease than those from least disadvantaged areas, with no evidence this association had changed over time (interaction p = 0.197). Living in less accessible areas independently increased the adjusted odds (OR = 1.18 1.09, 1.28]) of advanced disease, with some evidence that the geographical inequality had reduced over time (p = 0.045). Sensitivity analyses for un-staged cases showed that the original associations remained, regardless of assumptions made about the true stage distribution.ConclusionsBoth geographical and residential socioeconomic inequalities in advanced stage diagnoses persist, potentially reflecting barriers in accessing diagnostic services. Given the role of screening mammography in early detection of breast cancer, the lack of population-based data on private screening limits our ability to determine overall participation rates by residential characteristics. Without such data, the efficacy of strategies to reduce inequalities in breast cancer stage will remain compromised. |
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| Keywords: | Breast cancer Stage Geography Trends Socioeconomic |
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