Objectives: To identify differences in delay for surgical treatment of breast cancer between ethnic groups and to evaluate the role of health system, sociodemographic and tumour factors in ethnic inequities in breast cancer treatment.
Methods: A retrospective analysis of prospectively collected data from the Waikato Breast Cancer Register for cancers diagnosed in the Waikato region in New Zealand (NZ) from 1 January 2005 to 31 December 2010.
Results: Approximately 95% (1449 out of 1514) of women with breast cancer diagnosed in the Waikato over the study period were included. Of women undergoing primary surgery (n = 1264), 59.6% and 98.2% underwent surgery within 31 and 90 days of diagnosis, respectively. Compared with NZ European women (mean 30.4 days), significantly longer delays for surgical treatment were observed among Māori (mean = 37.1 days, p = 0.005) and Pacific women (mean = 42.8 days, p = 0.005). Māori women were more likely to experience delays longer than 31 (p = 0.048) and 90 days (p = 0.286) compared with NZ European women. Factors predicting delays longer than 31 and 90 days in the multivariable model included public sector treatment (OR 5.93, 8.14), DCIS (OR 1.53, 3.17), mastectomy (OR 1.75, 6.60), higher co-morbidity score (OR 2.02, 1.02) and earlier year of diagnosis (OR 1.21, 1.03). Inequities in delay between Māori and NZ European women were greatest for women under 50 years and those older than 70 years.
Conclusion: This study shows that significant inequities in timely access to surgical treatment for breast cancer exist in NZ, with Māori and Pacific women having to wait longer to access treatment than NZ European women. Overall, a high proportion of women did not receive surgical treatment for breast cancer within the guideline limit of 31 days. Urgent steps are needed to reduce ethnic inequities in timely access to breast cancer treatment, and to shorten treatment delays in the public sector for all women.
Keywords: breast cancer; cancer registry; ethnicity; inequity; treatment delay.