Women with breast cancer worse off in rural Australia, study shows

Neelima Choahan

2/05/2018 4:44:52 PM

New research shows women with breast cancer in rural Australia have lower survival rates and different health outcomes than those living in the cities.

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The Cancer Council Queensland study found women living in non-metropolitan areas had lower survival and were more likely to undergo a mastectomy than women in metropolitan areas.

When Suzanne Granshaw was diagnosed with cancer at just 34, she had to face the trauma of losing her breast and undergoing chemotherapy.  
What made it more difficult for the mother-of-three from rural Queensland was juggling medical appointments around her family’s needs as she sought treatment in Townsville and Ayr, both more than an hour’s drive away from her home in the small farming community of Dalbeg. 
‘I had to drive to Ayr [for an hour] to get my results from my GP. When I went in to see her she said, “It’s not good news, it’s cancer”,’ Ms Granshaw told newsGP.
‘I had three children with me in the waiting room and I [had] brought my younger brother [11] … and then the same day the [GP] sent me to see the surgeon … and he said, “We need to take your whole breast off”.’
Ms Granshaw, who fell sick 14 years ago, told newsGP living in a remote township like Dalbeg meant she and her family had to drive hours just to get to medical appointments.
New research into published evidence has found that regional women with breast cancer across Australia face a general pattern of poorer survival and variations in clinical management when compared to women in metropolitan areas.
The Cancer Council Queensland study, published in BMJ Open, looked at peer-reviewed articles in English published from 1 January 1990 to 24 November 24 2017.
Cancer Council Queensland Head of Research Professor Joanne Aitken told newsGP that although there was a variation in the quality of the studies and a lack of standardisation in terminology used to define non-urban and metropolitan areas, a clear pattern had emerged.
‘Compared to metropolitan women, women living in non-metropolitan areas had lower survival and were more likely to undergo a mastectomy rather than breast-conserving surgery for early breast cancer,’ Professor Aitken said.
‘Women living in non-metropolitan areas were also less likely to undergo sentinel node biopsies, receive post-surgery radiotherapy or breast reconstruction after a mastectomy, compared to women living in metropolitan areas.’
According to Cancer Council Queensland, an estimated 18,000 women in Australia will be diagnosed with breast cancer in 2018. While five-year relative survival is at 90%, treatment choices can affect quality of life long after treatment has finished for cancer survivors.
Professor Aitken said it is not clear from the study why the differences exist.
‘What we were not able to say was why these differences exist, but there is a difference in treatment. For example, access to high-volume breast cancer surgeons is lower, multidisciplinary care, radiotherapy, all of these things by virtue of distance are lower outside cities than within cities,’ she said.
‘That eventually has an impact on treatment and outcomes.’
Professor Aitken said women in non-metropolitan areas should be able to have the same rate of survival as in the city.
‘It’s vital that all women, no matter where they live, have the opportunity to access suitable treatment and care options that will improve quality of life long after treatment,’ she said.
Dr Mel Considine, who lives in Clare, South Australia, practised as a GP in three small towns on the state’s Eyre Peninsula in 2014. She told newsGP patients had to travel up to three hours to Port Augusta, Whyalla or Port Lincoln for radiology, or up to seven hours to Adelaide for more advanced care.
‘The rates of many conditions are higher and outcomes are worse for rural people, particularly because of access issues for medical care, not just specialised care but also for primary care,’ Dr Considine said.
Asked if things would have been easier had she been living in a city when she fell sick, Ms Granshaw said, ‘Definitely’.
‘I was lucky I did catch it in time, but when you have got school children, you’ve either got to take them with you or find someone to look after them,’ she said.

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