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Int. J. Environ. Res. Public Health 2017, 14(4), 427; doi:10.3390/ijerph14040427

Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country

1
National Clinical Research Centre, Ministry of Health, Kuala Lumpur 50586, Malaysia
2
Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
3
Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
4
Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
5
Subang Jaya Medical Centre, Subang Jaya, Selangor 47500, Malaysia
*
Author to whom correspondence should be addressed.
Academic Editor: Peter Baade
Received: 22 February 2017 / Revised: 12 April 2017 / Accepted: 13 April 2017 / Published: 16 April 2017
(This article belongs to the Special Issue Geographical Variation in Breast Cancer Outcomes)
View Full-Text   |   Download PDF [276 KB, uploaded 16 April 2017]

Abstract

Background: Survival disparities in cancer are known to occur between public and private hospitals. We compared breast cancer presentation, treatment and survival between a public academic hospital and a private hospital in a middle-income country. Methods: The demographics, clinical characteristics, treatment and overall survival (OS) of 2767 patients with invasive breast carcinoma diagnosed between 2001 and 2011 in the public hospital were compared with 1199 patients from the private hospital. Results: Compared to patients in the private hospital, patients from the public hospital were older at presentation, and had more advanced cancer stages. They were also more likely to receive mastectomy and chemotherapy but less radiotherapy. The five-year OS in public patients was significantly lower than in private patients (71.6% vs. 86.8%). This difference was largely attributed to discrepancies in stage at diagnosis and, although to a much smaller extent, to demographic differences and treatment disparities. Even following adjustment for these factors, patients in the public hospital remained at increased risk of mortality compared to their counterparts in the private hospital (Hazard Ratio: 1.59; 95% Confidence Interval: 1.36–1.85). Conclusion: Late stage at diagnosis appears to be a major contributing factor explaining the breast cancer survival disparity between public and private patients in this middle-income setting. View Full-Text
Keywords: breast cancer; overall survival; public vs. private hospital breast cancer; overall survival; public vs. private hospital
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Kong, Y.-C.; Bhoo-Pathy, N.; Subramaniam, S.; Bhoo-Pathy, N.; Taib, N.A.; Jamaris, S.; Kaur, K.; See, M.-H.; Ho, G.-F.; Yip, C.-H. Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country. Int. J. Environ. Res. Public Health 2017, 14, 427.

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