Kou Kou, Cameron Jessica, Dasgupta Paramita, Price Aiden, Chen Hao, Lopez Derrick, Mengersen Kerrie, Hayes Sandi, Baade Peter
Cancer Council Queensland, Brisbane, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
Cancer Council Queensland, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Centre for Data Science, Faculty of Science, Queensland University of Technology, Brisbane, Australia.
Cancer Epidemiol. 2024 Dec;93:102681. doi: 10.1016/j.canep.2024.102681. Epub 2024 Oct 3.
Breast cancer is the most commonly diagnosed cancer among women worldwide. While previous studies have reported urban and rural differences in breast cancer outcomes, the level of heterogeneity within these broad regions is currently unknown.
Population-level data from Queensland Cancer Register including 58,679 women aged at least 20 years who were diagnosed with breast cancer in Queensland, Australia, 2000-2019 were linked to BreastScreen Queensland and Queensland Hospital Admitted Patients Data Collection to estimate five breast cancer outcomes: incidence, proportion of localised disease and screen-detected cases (via public-funded program), surgical rates, and 5-year survival. Bayesian spatial models were used to smooth outcomes across 512-517 small areas in Queensland.
The incidence of breast cancer was not proportionally distributed, with urban regions having higher rates. Less than half (47 %) of women were diagnosed with localised disease, 91 % had surgery, with five-year relative survival of 92 %. There was no evidence of geographic variation in the proportion of localised disease, surgical rates, or survival over Queensland. Publicly-funded screening detected 38 % of cases, with lower proportion of screen-detected cases observed in Queensland's urbanised south-east corner.
Although the disparities in health outcomes faced by Australians living in rural areas have received increased attention, this study found limited evidence for spatial variation in breast cancer outcomes along the continuum of care across Queensland. These results suggest the detection and management practices for breast cancer may provide an achievable benchmark for other cancer types in reducing the geographical disparity in cancer outcomes.
乳腺癌是全球女性中最常被诊断出的癌症。虽然先前的研究报告了乳腺癌治疗结果的城乡差异，但目前尚不清楚这些广大区域内的异质性水平。
来自昆士兰癌症登记处的人群水平数据，包括2000年至2019年在澳大利亚昆士兰州被诊断出患有乳腺癌的58679名至少20岁的女性，与昆士兰乳房筛查和昆士兰医院住院患者数据收集相关联，以估计五项乳腺癌治疗结果：发病率、局部疾病比例和筛查发现的病例（通过公共资助项目）、手术率以及5年生存率。使用贝叶斯空间模型对昆士兰州512 - 517个小区域的治疗结果进行平滑处理。
乳腺癌的发病率分布不均衡，城市地区发病率更高。不到一半（47%）的女性被诊断为局部疾病，91%的患者接受了手术，5年相对生存率为92%。在昆士兰州，没有证据表明局部疾病比例、手术率或生存率存在地理差异。公共资助的筛查发现了38%的病例，在昆士兰州城市化程度较高的东南角，筛查发现的病例比例较低。
尽管生活在农村地区的澳大利亚人所面临的健康结果差异受到了更多关注，但本研究发现，昆士兰州在整个连续医疗过程中，乳腺癌治疗结果的空间差异证据有限。这些结果表明，乳腺癌的检测和管理实践可能为其他癌症类型减少癌症治疗结果的地理差异提供一个可实现的基准。
