Geographic variation in the intended choice of adjuvant treatments for women diagnosed with screen-detected breast cancer in Queensland

BMC Public Health

Research Article

Susanna M. Cramb¹  Peter D. Baade¹  Kerrie L. Mengersen²  James M. McGree²  Jeff Ching-Fu Hsieh²  Nathan A. M. Dunn³ 

[1] Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia;Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia;Preventive Health Unit, Department of Health, Brisbane, Queensland, Australia;

关键词: Adjuvant therapies;    Bayesian shared spatial-component model;    Breast cancer;    Mammography screening;    Spatial inequalities;   

DOI  :  10.1186/s12889-015-2527-2

 received in 2015-03-11, accepted in 2015-11-18,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundAlthough early diagnosis and improved treatment can reduce breast cancer mortality, there still appears to be a geographic differential in patient outcomes. This study aims to determine and quantify spatial inequalities in intended adjuvant (radio-, chemo- and hormonal) therapy usage among women with screen-detected breast cancer in Queensland, Australia.MethodsLinked population-based datasets from BreastScreen Queensland and the Queensland Cancer Registry during 1997−2008 for women aged 40−89 years were used. We adopted a Bayesian shared spatial component model to evaluate the relative intended use of each adjuvant therapy across 478 areas as well as common spatial patterns between treatments.ResultsWomen living closer to a cancer treatment facility were more likely to intend to use adjuvant therapy. This was particularly marked for radiotherapy when travel time to the closest radiation facility was 4 + h (OR =0.41, 95 % CrI: [0.23, 0.74]) compared to <1 h. The shared spatial effect increased towards the centres with concentrations of radiotherapy facilities, in north-east (Townsville) and south-east (Brisbane) regions of Queensland. Moreover, the presence of residual shared spatial effects indicates that there are other unmeasured geographical barriers influencing women’s treatment choices.ConclusionsThis highlights the need to identify the additional barriers that impact on treatment intentions among women diagnosed with screen-detected breast cancer, particularly for those women living further away from cancer treatment centers.

【 授权许可】

CC BY   
© Hsieh et al. 2015