Inequitable Ethnic and Rural Variations in Mammographic Surveillance of Breast Cancer Survivors in Regional Aotearoa New Zealand

Objective

New Zealand and international guidelines recommend surveillance mammography in breast cancer survivors. Ethnic breast cancer-specific diagnosis, treatment and survival inequities exist in Aotearoa New Zealand. Surveillance mammography uptake remains poorly studied internationally and has never been studied in AoNZ. We aim to study surveillance mammography uptake in our region and to probe for unrecognised ethnic and rural inequities.

Design

Retrospective cohort study.

Setting

Taranaki, Aotearoa New Zealand.

Participants

Surveillance mammogram candidates who received potentially curative surgery for breast cancer between January 2008 and December 2010.

Main Outcome Measure

Patients' surveillance mammogram opportunity fulfilment rates in the first 10 post-operative years were analysed using a multivariable logistic regression analysis.

Results

Only two thirds of all surveillance mammogram opportunities in our patient's first ten post-operative years were fulfilled. Fulfilment rates decrease significantly with time. Māori and those living rurally are significantly less likely to reach fulfilment rates of ≥ 70% even when accounting for covariates such as age, deprivation, healthcare system and oncology follow up.

Conclusion

Healthcare providers have a responsibility to distribute the benefits of health care equitably. This study reports previously unrecognised inequities affecting Māori and rural patients and calls for further research and policy to improve engagement of breast cancer survivors with surveillance mammography and healthcare equity in AoNZ.