Breast cancer outcomes better in cities – new study

Wednesday, September 5, 2012

 

A new breast cancer study has found that people with breast cancer receiving treatment in major cities tend to have a greater chance of surviving their breast cancer than those treated in inner regional areas.

This study is reported in the most recent edition of the Australian Health Review, the peer reviewed journal of the Australian Healthcare and Hospitals Association.

“International evidence indicates that treatment outcomes vary depending on people’s private health insurance status, their treatment locations and numbers of other breast cancer patients being treated by their surgeon,” said the lead author, Professor David Roder, Senior Population Health Advisor, Cancer Australia.

“The study aimed to determine whether survival from breast cancer varied with these factors in the Australian context. It used data from the Australian National Breast Cancer Audit to compare case fatality by surgeon case load, treatment centre location and health insurance status, with deaths from cancers diagnosed in 1998–2005 and followed to 31 December 2007.

“Our analysis found that compared with major city centres, people with breast cancer treated at inner regional centres had a slightly higher relative risk of death from their breast cancer, but the risk was not elevated for more remote sites. The reasons for this difference are not clear and require further study.

“We also found that when adjustment was made for age and clinical risk factors, the relative risk of breast cancer death was lower when surgeons’ annual caseloads exceeded 20 cases per year.

However, these relative risks were not statistically significant when also adjusting for treatment centre location. Despite this, we recommend that this issue be further examined as in our study it was difficult to separate the impact of treatment location from that of surgeon caseload, given that treatment centres in regional and remote areas tend to have lower caseloads than those in major cities.

“According to our analysis, risk of death of people with breast cancer from their breast cancer was not related to private insurance status. This indicated that in Australia, patients without private health insurance can expect to have similar treatment outcomes as those who are insured. This differs from countries such as the USA where uninsured cancer patients typically have poorer outcomes and we attribute this finding to Australia’s system of universal health insurance.

“This study provides impetus for further research to determine reasons for apparent differences in breast cancer survival. Issues related to patients such as levels of co-morbidity and issues related to service delivery could all play a role and warrant further research” Professor Roder said.

For more information and comment:  Professor David Roder  047 840 8386