Data from the BreastSurgANZ Quality Audit was used to analyse how the place a patient lives-city, inner regional, outer regional or remote-can affect the treatment they receive for breast cancer.
Location and method of diagnosis
A core biopsy (inserting needle through a cut in skin to remove a small amount of tissue) was the most commonly performed method of diagnosis across all regions. Open biopsy (cutting breast to take out part of lump) was the least common.
Patients in remote areas were more likely to be diagnosed from an open biopsy than those living in the city (13.8% compared with 9.8%). This difference may be due to patient participation in breast screening programs being lower in remote areas (less invasive diagnosis methods being more common in screened patients than in patients who presented to their GP with symptoms) and these areas having less access to specialists trained in the less invasive methods of diagnosis.
Location and type of surgery
Breast conserving surgery (removal of breast cancer and small amount of surrounding healthy tissue) was the most commonly performed surgery across all regions. The proportion having this surgery decreases and the proportion having mastectomy (surgical removal of the breast) increases with increasing remoteness, with the exception of remote locations.
It is proposed that this decrease in breast conservation and increase in mastectomy not being seen in remote locations is due to remote patients relocating to the city for breast cancer management to avoid the lack of specialty services in their area.
Breast reconstruction (surgery to rebuild the breast) was uncommon in all regions (4% or below), with no surgery at all even less common (1.5% or below). The proportion of patients having no surgery at all decreases with further remoteness of residence.
Australian Institute of Health and Welfare figures show a high proportion of Australians over 70 years of age live in the city. The higher number of 'no surgery' cases seen in the city may then be due to elderly patients opting to proceed with no surgical intervention.
Location and radiotherapy
This study found patients living in a city were more likely to receive radiotherapy than patients in other locations. Also, patients living in an area lacking a radiotherapy facility were less likely to have radiotherapy.