Female breast cancer in New South Wales, Australia, by country of birth: implications for health-service delivery

BackgroundNSW has a multicultural population with increasing migration from South East Asia, the Western Pacific and Eastern Mediterranean.ObjectiveTo compare cancer stage, treatment (first 12months) and survival for 12 country of birth (COB) categories recorded on the population-based NSW Cancer Registry.DesignHistoric cohort study of invasive breast cancers diagnosed in 2003-2016.PatientsData for 48,909 women (18+ ages) analysed using linked cancer registry, hospital inpatient and Medicare and pharmaceutical benefits claims data.MeasurementComparisons by COB using multivariate logistic regression and proportional hazards regression with follow-up of vital status to April 30th, 2020.ResultsCompared with the Australia-born, women born in China, the Philippines, Vietnam and Lebanon were younger at diagnosis, whereas those from the United Kingdom, Germany, Italy and Greece were older. Women born in China, the Philippines, Vietnam, Greece and Italy lived in less advantaged areas. Adjusted analyses indicated that: (1) stage at diagnosis was less localised for women born in Germany, Greece, Italy and Lebanon; (2) a lower proportion reported comorbidity for those born in China, the Philippines and Vietnam; (3) surgery type varied, with mastectomy more likely for women born in China, the Philippines and Vietnam, and less likely for women born in Italy, Greece and Lebanon; (4) radiotherapy was more likely where breast conserving surgery was more common (Greece, Italy, and Lebanon) and the United Kingdom; and (5) systemic drug therapy was less common for women born in China and Germany. Five-year survival in NSW was high by international standards and increasing. Adjusted analyses indicate that, compared with the Australian born, survival from death from cancer at 5 years from diagnosis was higher for women born in China, the Philippines, Vietnam, Italy, the United Kingdom and Greece.ConclusionsThere is diversity by COB of stage, treatment and survival. Reasons for survival differences may include cultural factors and healthier migrant populations with lower comorbidity, and potentially, less complete death recording in Australia if some women return to their birth countries for treatment and end-of-life care. More research is needed to explore the cultural and clinical factors that health services need to accommodate.

Automated summary

The study found diversity in cancer stage, treatment, and survival among women from different countries of birth, with differences in age at diagnosis, area of residence, treatment received, and survival rates. Compared to Australian-born women, those born in China, the Philippines, Vietnam, Italy, the United Kingdom, and Greece had higher 5-year cancer survival rates. Further research is needed to explore the cultural and clinical factors that may impact healthcare services for migrant populations.