Aims
While on average Australia has high breast cancer survival compared to international benchmarks, there is evidence that nonmetropolitan and Indigenous women experience poorer outcomes. This study aimed to identify and analyse factors contributing to poorer breast cancer outcomes for these women.
Methods
Cancer Australia engaged Cancer Council Queensland to undertake an evidence review to identify and analyse factors contributing to poorer breast cancer outcomes for nonmetropolitan and Indigenous women at one or more steps along the breast cancer continuum of care. The scientific literature review included published evidence between 1990 and 2015 and was focused across four themes: survival outcomes, patient and tumour characteristics, diagnostic and treatment outcomes, and psychosocial outcomes. A national scoping activity was undertaken to identify unpublished studies, reports and epidemiological and health service data. A report was developed summarising findings and priorities for future policy, practice and research.
Results
Of the initial 114 articles identified during the systematic searches, 16 met inclusion criteria for the review. Despite evidence gaps, which reflect variability among studies and a predominance of state-specific studies, the review found evidence that factors contributing to poorer survival may include differences in screening rates, time of diagnosis, type of treatment and other health and socioeconomic factors. For Indigenous women, in addition to these factors, cultural beliefs and social determinants of health may also contribute to poorer survival.
Conclusions
A number of factors were identified which may contribute to the poorer breast cancer outcomes of nonmetropolitan and Indigenous women. Based on the evidence reviewed, priorities have been identified to improve breast cancer outcomes for non-metropolitan and Indigenous women across the continuum of care. Given the limitations in the availability of evidence, priorities include further developing the evidence base to address key gaps in knowledge and improve the quality of future research.