Disparities in breast cancer care uncovered

A new study has deepened understanding of why Aboriginal and Torres Strait Islander women can experience poorer outcomes from breast cancer compared to non-Indigenous women.
 
The research, co-designed with Aboriginal communities and published in Cancer Epidemiology, Biomarkers & Prevention, focused on the experiences of Aboriginal and Torres Strait Islander women in Victoria who continue to face both higher incidence and mortality rates from breast cancer than non-Aboriginal and Torres Strait Islander women.
 
Using data from the Victorian Cancer Registry, researchers analysed outcomes for 395 Aboriginal and/or Torres Strait Islander women and 57,618 non-Indigenous women diagnosed with breast cancer between 2008 and 2021.
 
The findings revealed that Aboriginal and Torres Straight Islander women are diagnosed at a median age of 56 compared to 61 for non-Indigenous women and presented with more advanced disease.
 
Lead author, medical oncologist Dr Alice Bergin, who is a PhD candidate at the Peter MacCallum Cancer Centre, said the study emphasises the need to address socioeconomic inequities, as well as ensuring the delivery of culturally safe healthcare.
 
‘This must be addressed,’ she told newsGP.
 
‘Socioeconomic inequity is associated with poorer health outcomes for a range of health conditions, including cancer.
 
‘Culturally safe healthcare is [also] critically important. Aboriginal and Torres Strait Islander people need to feel safe and empowered when they are seeking care for any health condition.
 
‘Culturally safe healthcare is not uniform and will vary according to the person and their preferences, the clinical setting and the location of their care.’
 
Breast cancer remains the most common cancer diagnosed among women, with around 21,000 new cases expected to be diagnosed in Australia in 2025.
 
Aboriginal and Torres Strait Islander women are 0.9 times as likely to be diagnosed, and 1.2 times more likely to die from breast cancer, with the five-year relative survival rate 81% compared to 90% for the non-Indigenous population.
 
Despite this, Dr Bergin said the data her team used from the Victorian Cancer Registry appeared to under-represent Aboriginal and Torres Strait Islander women with breast cancer in the community.
 
While she says this is due to a ‘multitude of factors’, she notes that rectifying this comes back to cultural safety.
 
‘[It] is paramount,’ Dr Bergin said.
 
‘All healthcare environments should strive to ensure people feel safe and empowered to disclose their cultural identity and then have mechanisms in place to support that person, whatever their needs.’
 
The research is part of a broader national collaboration involving clinicians, scientists and researchers, as well as Aboriginal and Torres Strait Islander women from Victoria, Western Australia and Queensland.
 
As part of the study, the team also assessed the immune responses in early-stage breast cancer samples from Aboriginal and Torres Strait Islander women in Western Australia. The research focused on levels of stromal tumour-infiltrating lymphocytes (sTILs), which are a marker of the body’s immune response to cancer.
 
Results showed significantly reduced sTILs in luminal and triple-negative subtypes of breast cancers in Aboriginal and Torres Strait Islander women compared to those of non-Indigenous women listed in The Cancer Genome Atlas.
 
Prior to this, Dr Bergin said the research question had not been posed for Aboriginal and Torres Strait Islander women.
 
‘So, [we] weren’t sure what the initial analysis was going to show,’ she said.
 
‘However, we do know that when diverse groups of women with early-stage breast cancer are compared, significant differences in the immune infiltrate have been found.
 
‘The number of breast cancers from Aboriginal and Torres Strait Islander women used in this analysis was relatively small and the study was retrospective, so these are limitations of the study.
 
‘Further work is underway to understand the composition (type of immune cells) in the immune infiltrate and this will help guide the next steps in consultation with community. The research process is very dynamic.’
 
In some jurisdictions, Aboriginal and Torres Strait Islander women are encouraged to begin breast cancer screening at age 40.
 
To improve cancer outcomes, initiatives are currently underway to help remove barriers to screening and boost participation rates. An example of this in Victoria is the Beautiful Shawl Project.
 
An Aboriginal-led initiative that started in 2018, BreastScreen Victoria and the Victorian Aboriginal Community Controlled Health Organisation partner with Aboriginal Community Controlled Organisations to provide Aboriginal and Torres Strait Islander women with a specially designed shawl that offers comfort and empowerment during screening appointments, which they take home as a gift.
 
Now a part of the Victorian Government’s Cancer Plan for 2024–2028, 406 screenings were completed through the initiative in 2023–24, up 39.5% on the previous year.
 
Dr Bergin says this type of community-led and designed collaboration is vital when it comes to research.
 
‘Aboriginal and Torres Strait Islander community members must be involved in every step of the research process, from initial research idea or proposal through to ethics and grant applications, the analysis, conclusions and then feedback to the community,’ she said.
 
Last year, the RACGP launched its updated National Guide to preventive healthcare for Aboriginal and Torres Strait Islander people, which includes a chapter on cancer prevention and early detection, and information on breast cancer specifically.
 
Log in below to join the conversation

Aboriginal and Torres Strait Islander breast cancer cultural safety women’s health