Project summary

Background

New Zealand has the seventh highest age standardized mortality rate from breast cancer (BC) in the world. The statistics for Māori and Pacific women are even worse. Inequalities may be due to differences in stage at diagnosis, access to treatment, in the timeliness and quality of care or may be due to differences in cancer biology. The Auckland and Waikato Cancer Registries have collected detailed data on women with BC since 2000 and have a unique population based sample of New Zealand women including a significant proportion of Māori and Pacific women. Examination of outcomes in women based on their clinical and biological characteristics as well as the treatment modality used will allow us to better understand the inequities and allow targeting of interventions to the areas of highest need.  Recently, efforts have been made to improve the quality of care for women with BC through the appointment of BC care coordinators. We believe that if these coordinators have an understanding of the main influences on adverse outcomes they will be able to better target the women at highest risk.

 

The study

This study will include approximately 12500 women with newly diagnosed BC and includes 1200 Māori and 850 Pacific women. Comprehensive data has been collected and recorded on the registers include demographic details, mode and characteristics at presentation, co-morbidities, investigations, treatment (types of treatments and dates) and outcomes (free of disease, recurrence of disease, death). We envisage undertaking a number of studies with the completed dataset:

  1. To determine the impact of ethnicity, deprivation, residence and screening on cancer stage at diagnosis.
  2. To determine the effect of age, residence, ethnicity, public/private treatment and screen / symptomatic presentation on delay and/or quality of care (delay in primary and/or adjuvant therapy, usage of adjuvant therapy)
  3. To determine differences by ethnicity in cancer biology (histology, grade, ER/PR/HER-2)
  4. To determine differences by ethnicity in BC outcomes including first recurrence and mortality both due to and independent of stage at diagnosis and identify the quantitative impact of such factors in ethnic differences in BC outcomes
  5. We will then pilot an intervention for women with BC at high risk of poor outcomes and/or inequities based on the activities of cancer care coordinators.

 

Research impact  

Large numbers of NZ women are at risk of losing many years of potential life due to BC. Consequently, this is a disease where greater understandings of the reasons why Māori and Pacific women have such poor prognoses have the greatest potential to both improve outcomes and reduce inequities. Recent research has suggested that while some of the inequities may be due to differences in extent of disease at diagnosis, there remains an important contribution from issues such as quality of BC treatment e.g. delays in the treatment pathway, sub-optimal use of endocrine and chemotherapy. This study has the potential to improve outcomes for women at highest need through ensuring they receive optimal treatment. While early diagnosis and preventative strategies can have an impact, we believe that by targeting women with established BC and improving care we will make the quickest impact on improving outcomes.