Objective Aboriginal and Torres Strait Islander women have a higher mortality rate due to gynecologic cancer compared with non-Indigenous women. For cervical cancer, Australian Indigenous women are less likely to survive 5 years following diagnoses than non-Indigenous women. This study investigates the factors associated with gynecologic cancer treatment and survival among Queensland indigenous and non-Indigenous women.
Methods Australian Indigenous women diagnosed with uterine, cervical, ovarian, or other gynecologic cancers during 1998–2004 in the public hospital system were included. They were frequency matched on age (±5 years), residential remoteness, and cancer type to a random sample of non-Indigenous women. One- and 5-year cancer-specific survival was examined according to Indigenous status using Cox proportional hazards regression.
Results Indigenous women (n = 137) compared with non-Indigenous women (n = 120) were less likely to be diagnosed with localized disease (49% vs 65%, P = 0.02) and had more comorbidities (52% vs 21%, P < 0.001). Indigenous women were less likely to receive any cancer treatment compared with non-Indigenous women (91% vs 98%, P = 0.01), although when excluding those with metastatic cancer, there was no significant difference in uptake of treatment (95% vs 91%, respectively, P = 0.31). Among those who did undergo treatment, there was no difference in time to treatment (median difference 0.5 days, P = 0.98). Gynecologic cancer–specific survival differences between Indigenous and non-Indigenous women were most prominent in the first year following diagnosis (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.06–3.38) and were no longer significant 5 years after diagnosis (HR, 1.47 [95% CI, 0.97–2.25]). For cervical cancer, crude 1-year survival was poorer for Indigenous women compared with non-Indigenous women (HR, 2.46 [95% CI, 1.03–5.90]), but was no different when adjusted for stage and treatment of cancer (HR, 1.00 [95% CI, 0.45–2.24]).
Conclusions Improving the early diagnosis of cervical cancer in Indigenous women may increase cancer-specific survival in the year following diagnosis.
- Indigenous survival
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A.D. was supported during the write-up of the manuscript by a National Health and Medical Research Council (NHMRC) Training Scholarship for Indigenous Australian Health Research (no. 1055587). S.P.M. was supported by an NHMRC Training Scholarship for Indigenous Australian Health Research (no. 389935) and an International Agency for Research on Cancer–Cancer Council Australia postdoctoral fellowship. The NHMRC Project Grant (no. 1004643) partly funded this project. S.P.M. and P.C.V. were also supported by the former Australian Centre for International and Tropical Health, UQ. A.C.G. was partly supported by a fellowship from the UK Medical Research Council (no. 89912). P.C.V. was supported by an Australian Research Council Future Fellowship (no. 100100511). This work was produced as part of the In-Kind activities of the Lowitja Institute incorporating the Cooperative Research Centre for Aboriginal and Torres Strait Islander Health.
The authors declare no conflicts of interest.