ORIGINAL ARTICLERural–urban differences in the presentation, management and survival of breast cancer in Western Australia
Introduction
People living in rural areas have less access to health care and facilities, and incur higher costs, compared with their urban counterparts.1 Recent studies have indicated that rural women diagnosed with breast cancer have a later stage of cancer at diagnosis,2, 3 undergo fewer diagnostic investigations,4 are less likely to have breast-conserving surgery5, 6 and radiotherapy,7 and are less likely to be treated by a high caseload surgeon8 than women living in urban areas. Research has shown mixed results regarding the likelihood of rural women undergoing mammographic screening compared with urban women.9, 10 Australian statistics show similar mortality rates for breast cancer in urban and rural areas.1, 11
Approximately 30% of Western Australia's (WA's) population lives in rural or remote areas. All breast cancer screening, diagnostic and treatment services are available in the capital city, Perth. Some of these services are also available in regional centres, and mobile mammography units provide screening in rural and remote areas.
This study used data from all women diagnosed with breast cancer in WA in 1999 to investigate whether differences exist between women living in urban and rural areas in the presentation, investigation, primary treatment and 5-year survival from breast cancer.
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Methods
The methods for this study have been described previously12, 13 and are briefly summarised here.
Results
There were 1025 women diagnosed with invasive breast cancer in 1999 and notified to the WA Cancer Registry. Of these 899 (88%) were included in the analysis. Cases were excluded if the tumour was not an incident tumour but had recurred in 1999, if the tumour was secondary from somewhere other than the breast or if the tumour was not confirmed histologically. Some eligible women were not included because the woman's doctor refused to permit access to medical records following changes to the
Discussion
In this study, we found no significant differences in the characteristics of tumours at presentation between urban and rural women with breast cancer. This contradicts previous research, which has suggested that breast cancers in rural women are diagnosed at a later stage than those in women from urban areas.2, 3 Our finding may reflect the continuing development of mammographic services in WA in the intervening decade. But it also means that differences in the investigation and management of
Conclusions
Despite similarities in mode of presentation and tumour characteristics, women with breast cancer from rural WA experience a poorer survival outcome than their urban counterparts. This survival difference seems to be largely due to variations in treatment and surgeon caseload between rural and urban cases. From the data to hand, we cannot tell whether these disparities arise from inadequate information among rural patients and practitioners, the tyrannies of distance, or incomplete availability
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