Ethnic, socio‐demographic and socio‐economic differences in surgical treatment of breast cancer in New Zealand

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In 1990, a Consensus Statement from the US National Institutes of Health recommended that either breast conserving surgery (BCS) followed by whole breast irradiation or total mastectomy as local therapies of equal oncological efficacy for early stage breast cancer.1 The efficacy and safety of sentinel lymph node biopsy (SNB)‐based management for clinically node negative early breast cancer have been well established for more than a decade, and were absolutely confirmed with the publication of the large National Surgical Adjuvant Breast and Bowel Project randomized trial in 2010.2 SNB has been formally recommended in Australia and New Zealand for women with unifocal breast cancers less than 3 cm in size since 20083 and has gained wide acceptance as the standard of care for those women.4 A majority of breast cancers nowadays are diagnosed in early stage, and hence, are suitable for BCS and/or SNB‐based management, resulting not only in better cosmetic outcomes, but also in lower physical and psychological morbidity for a majority of women.5 Even for the minority of women requiring mastectomy because of oncological reasons, advances and wider availability of cosmetic and reconstructive surgery have seen a steady increase in rates of post‐mastectomy breast reconstructions.7
Many non‐tumour‐related factors including age, comorbidity, patient/surgeon preference and availability and access to healthcare services have been shown to influence the decision on type of surgical treatment for breast cancer.8 Many of these factors also contribute to ethnic, socio‐economic and geographic variations in quality and type of surgical care, which are well documented from many countries.9 These variations include lower rates of BCS, SNB, post‐mastectomy breast reconstruction and definitive local therapy among women of minority/Indigenous ethnicity, lower socio‐economic status and rural residency.12
Indigenous Māori women in New Zealand are known to experience inferior quality of cancer treatment compared with NZ Europeans for many cancers.15 For example, Māori have been reported to have a lower likelihood of undergoing surgery for operable lung cancer,15 and to experience longer delays for surgical treatment of breast and lung cancer compared with NZ European patients.15 At present, limited data are available on quality or types of surgical treatment received by women with breast cancer in New Zealand19 or possible ethnic differences in such treatment. We investigated differences in rates of BCS, SNB, post‐mastectomy breast reconstruction and definitive local therapy for breast cancer by ethnicity among a cohort of women with invasive breast cancer in New Zealand. We also investigated tumour and socio‐demographic factors associated with these differences, and time trends in disparities in surgical care between Māori and NZ European women.

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