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Detection of Later Stage Breast Cancer in First Nations Women in Ontario, Canada

  • Quantitative Research 2009
  • 2009 Student Award Winner
  • Published:
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Abstract

Objective

To compare the distribution of stage at breast cancer diagnosis between First Nations (FN) and non-FN women, and to investigate factors associated with later diagnosis in FN women.

Methods

A case-case design was employed to compare FN women (N=287) to a frequency-matched random sample of women (N=671) from the general population diagnosed with breast cancer in the Ontario Cancer Registry. Women were matched (2:1) on period of diagnosis (1995–1999, 2000–2004), age at diagnosis (<50 vs. ≥50), and Regional Cancer Centre (RCC). Stage and data relevant to the determinants of stage were collected from medical charts at the RCCs. The association between stage (stage II+ vs. I) and FN status was modeled using logistic regression analyses; for FN women, the association between risk factors and stage was examined.

Results

FN women (66%) were diagnosed with a later stage significantly more often than non-FN women (56%). FN women with a non-screened cancer (OR 5.03, 95% CI 2.48–10.21) and those who were overweight or obese (OR 2.98, 95% CI 1.27–6.98 and OR 4.46, 95% CI 1.95–10.21, respectively) were significantly more likely to be diagnosed at a later stage. Having a comorbidity reduced the odds of a later stage (OR 0.51, 95% CI 0.27–0.96) in FN women.

Conclusion

This study demonstrates the need for FN women, in particular those who are not accessing the health care system, to participate in breast screening programs aimed at detecting breast cancers earlier with a better prognosis. These findings suggest that the cancer care system in Ontario should better target this population through increasing awareness and access to screening.

Résumé

Objectifs

Comparer la répartition des stades du cancer du sein au moment du diagnostic entre les femmes membres des Premières nations (PN) et les femmes qui n’en sont pas membres (non-PN), et étudier les facteurs associés au diagnostic tardif chez les femmes des PN.

Méthode

Nous avons mené une étude cas-cas pour comparer les femmes des PN (n=287) à un échantillon aléatoire apparié selon la fréquence, composé de femmes (n=671) de la population générale ayant un diagnostic de cancer du sein selon le Registre d’inscription des cas de cancer de l’Ontario. Les femmes ont été appariées (2:1) selon la période du diagnostic (1995–1999, 2000–2004), l’âge au diagnostic (<50 ans ou ≥50) et le Centre régional de cancérologie (CRC). Le stade et les données liées aux déterminants du stade ont été obtenus dans les dossiers médicaux des CRC. L’association entre le stade (stade II+ ou stade I) et l’appartenance ou non aux PN a été modélisée par régression logistique; pour les femmes des PN, nous avons examiné l’association entre les facteurs de risque et le stade.

Résultats

Les femmes des PN (66%) ont été diagnostiquées à un stade plus tardif significativement plus souvent que les femmes non-PN (56%). Les femmes des PN ayant un cancer non dépisté (RC 5,03, IC 95% 2,48–10,21) et celles qui faisaient de l’embonpoint ou qui étaient obèses (RC 2,98, IC 95% 1,27–6,98 et RC 4,46, IC 95% 1,95–10,21, respectivement) étaient de manière significative plus susceptibles de recevoir un diagnostic à un stade plus avancé. La présence d’une comorbidité réduisait la probabilité d’un diagnostic tardif (RC 0,51, IC 95% 0,27–0,96) chez les femmes des PN.

Conclusion

Cette étude montre que les femmes des PN, en particulier celles qui ne font pas appel au système de santé, auraient besoin de participer à des programmes de dépistage du cancer du sein qui visent à détecter ces cancers plus tôt pour en améliorer le pronostic. Le système de soins en cancérologie de l’Ontario devrait donc mieux cibler cette population en améliorant la sensibilisation et l’accès au dépistage.

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Authors and Affiliations

  1. Institute of Medical Science, University of Toronto, Toronto, ON, Canada

    Amanda J. Sheppard MSc, Anna M. Chiarelli PhD & Loraine D. Marrett PhD

  2. Population Studies and Surveillance, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada

    Amanda J. Sheppard MSc, Anna M. Chiarelli PhD, Loraine D. Marrett PhD, Lucia Mirea MSc & E. Diane Nishri MSc

  3. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Anna M. Chiarelli PhD, Loraine D. Marrett PhD & Lucia Mirea MSc

  4. Division of Medical Hematology-Oncology, Odette Cancer Centre, Toronto, ON, Canada

    Maureen E. Trudeau MD

  5. Princess Margaret Hospital, Canada

    Norman Boyd

  6. London Regional Cancer Centre, Canada

    Paul Ferner

  7. Hôpital régional de Sudbury Regional Hospital - Regional Cancer Program, Canada

    Amanda Hey

  8. Cancer Care Ontario, Canada

    Caroline Lidstone-Jones

  9. Cancer Centre of Southeastern Ontario, Canada

    Yolanda Madarnas

  10. Thunder Bay Regional Health Sciences Centre, Canada

    Alison McMullen

  11. Windsor Regional Cancer Program, Canada

    John Shaw

  12. Juravinski Cancer Centre, Canada

    Carol Rand

  13. Ottawa Hospital Cancer Centre, Canada

    Vincent Young

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  1. Amanda J. Sheppard MSc
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  2. Anna M. Chiarelli PhD
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  14. Carol Rand
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  15. Vincent Young
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the Aboriginal Breast Cancer Study Group

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Correspondence to Amanda J. Sheppard MSc.

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Sheppard, A.J., Chiarelli, A.M., Marrett, L.D. et al. Detection of Later Stage Breast Cancer in First Nations Women in Ontario, Canada. Can J Public Health 101, 101–105 (2010). https://doi.org/10.1007/BF03405573

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  • DOI: https://doi.org/10.1007/BF03405573

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