Effect of Community Population Size on Breast Cancer Screening, Stage Distribution, Treatment Use and Outcomes

• Published in: Canadian journal of public health 2012-01, Vol.103 (1), p.46-52
• Main Authors: Olson, Robert A., Nichol, Alan, Caron, Nadine R., Olivotto, Ivo A., Speers, Caroline, Chia, Stephen, Davidson, Ashley, Coldman, Andy, Bajdik, Chris, Tyldesley, Scott
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents; Biological and medical sciences; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - therapy; British Columbia - epidemiology; Cancer; Cancer patients; Cancer screening; Cancer therapies; Chemotherapy; Combined Modality Therapy - statistics & numerical data; Community; Diagnosis; Drug Utilization; Family physicians; Female; Gynecology. Andrology. Obstetrics; Health aspects; Health Services Accessibility; Humans; Mammary gland diseases; Mammography; Mass Screening - statistics & numerical data; Mastectomy; Mastectomy - methods; Mastectomy - statistics & numerical data; Medical examination; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous; Multivariate Analysis; Neoplasia; Outcome Assessment, Health Care; Patient outcomes; Population size; Prevention and actions; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; QUANTITATIVE RESEARCH; Radiation therapy; Radiotherapy; Radiotherapy, Adjuvant - statistics & numerical data; Resource management; Rural areas; Rural Health Services - statistics & numerical data; Rural populations; Studies; Survival Rate; Tumors; Women; Womens health
• ISSN: 0008-4263; 1920-7476
• DOI: 10.1007/BF03404068

Objective: Residents of rural communities have decreased access to cancer screening and treatments compared to urban residents, though use of resources and patient outcomes have not been assessed with a comprehensive population-based analysis. The objectives of this study were to investigate whether breast cancer screening and treatments were utilized less frequently in rural BC and whether this translated into differences in outcomes. Methods: All patients diagnosed with breast cancer in British Columbia (BC) during 2002 were identified from the Cancer Registry and linked to the Screening Mammography database. Patient demographics, pathology, stage, treatments, mammography use and death data were abstracted. Patients were categorized as residing in large, small and rural local health authorities (LHAs) using Canadian census information. Use of resources and outcomes were compared across these LHA size categories. We hypothesized that mastectomy rates (instead of breast-conserving surgery) would be higher in rural areas, since breast conservation is standardly accompanied by adjuvant radiotherapy, which has limited availability in rural BC. In contrast we hypothesized that cancer screening and systemic therapy use would be similar, as they are more widely dispersed across BC. Exploratory analyses were performed to assess whether disparities in screening and treatment utilization translated into differences in survival. Results: 2,869 breast cancer patients were included in our study. Patients from rural communities presented with more advanced disease (p= 0.01). On multivariable analysis, patients from rural, compared to urban, LHAs were less likely to be screening mammography attendees (OR=0.62; p