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An international comparison of breast cancer survival: Winnipeg, Manitoba and Des Moines, Iowa, metropolitan areas.

https://arctichealth.org/en/permalink/ahliterature186917
Source
Ann Epidemiol. 2003 Jan;13(1):32-41
Publication Type
Article
Date
Jan-2003
Author
Kevin M Gorey
Erich Kliewer
Eric J Holowaty
Ethan Laukkanen
Edwin Y Ng
Author Affiliation
School of Social Work, University of Windsor, Ontario, Canada. gorey@uwindsor.ca
Source
Ann Epidemiol. 2003 Jan;13(1):32-41
Date
Jan-2003
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - mortality
Female
Health Services Accessibility
Humans
Income
Internationality
Iowa - epidemiology
Manitoba - epidemiology
Medically Uninsured
Middle Aged
National Health Programs
Poverty
Registries
Abstract
Extending previous Canadian-United States cancer survival comparisons in large metropolitan areas, this study compares breast cancer survival in smaller metropolitan areas: Winnipeg, Manitoba and Des Moines, Iowa.
Manitoba and Iowa cancer registries, respectively, provided a total of 2,383 and 1,545 women with breast cancer (1984 to 1992, followed until December 31, 1997). Socioeconomic data for each person's residence at the time of diagnosis was taken from population censuses.
Socioeconomic status and breast cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Des Moines, residents of the lowest fifth of income areas in Winnipeg experienced a significant 5-year survival advantage (survival rate ratio [SRR] = 1.14). In these lowest income areas, the Canadian survival advantage was larger among women aged 25 to 64 years (SRR = 1.23), and this was observed in the middle fifth of income areas among this younger cohort (SRR = 1.11). The Canadian survival advantage even seemed apparent in the poorest neighborhoods with relatively high representations of Aboriginal people (SRR = 1.16).
This study replicated the finding of advantaged Canadian cancer survival in smaller metropolitan areas that had been consistently observed in larger metropolitan areas. Canada's single payer health care system seems to offer similar advantages across a number of diverse urban contexts.
Notes
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PubMed ID
12547483 View in PubMed
Less detail

Associations of physician supplies with breast cancer stage at diagnosis and survival in Ontario, 1988 to 2006.

https://arctichealth.org/en/permalink/ahliterature150658
Source
Cancer. 2009 Aug 1;115(15):3563-70
Publication Type
Article
Date
Aug-1-2009
Author
Kevin M Gorey
Isaac N Luginaah
Eric J Holowaty
Karen Y Fung
Caroline Hamm
Author Affiliation
School of Social Work, University of Windsor, Department of Mathematics and Statistics, Windsor, Ontario, Canada. gorey@uwindsor.ca
Source
Cancer. 2009 Aug 1;115(15):3563-70
Date
Aug-1-2009
Language
English
Publication Type
Article
Keywords
Breast Neoplasms - diagnosis - mortality
Female
Gynecology - statistics & numerical data
Humans
Neoplasm Staging
Ontario
Physicians - supply & distribution
Physicians, Family - supply & distribution
Abstract
The authors examined whether the supply of primary care physicians had protective effects on breast cancer stage and survival in Ontario and whether supply losses during the 1990s were associated with diminished protection.
Random samples of the Ontario Cancer Registry, respectively, provided 879 women and 951 women who were diagnosed with breast cancer between 1988 and 1990 (followed until 1996) and 1998 and 2000 (followed until 2006), respectively. Active physician supply data (1991 and 2001) joined to each woman's census division of residence was taken from the Scott's Medical Database.
Protective thresholds were observed among the earlier cohort for supplies of general practitioners (7 per 10,000 population) and supplies of obstetricians/gynecologists (6 per 100,000 population) at or above which women with breast cancer were significantly more likely to have been diagnosed with localized disease and to have survived for >or=5 years. These protective effects seemed generally attenuated among the more recent cohort. The risk of living in primary care physician-undersupplied areas increased significantly between 1991 and 2001 (10%-30%), and such physician supply losses were associated with reduced cancer care protection, including less prevalent early diagnoses (odds ratio [OR], 1.60; 95% confidence interval [95% CI], 1.00-2.58) and lower 5-year survival rates (OR, 1.62; 95% CI, 1.03-2.55).
Primary care physician supplies appeared to matter very much in the effective provision of cancer care in Canada. Community healthcare service endowments that include adequate physician supplies may be particularly critical to the performance of a healthcare system such as that in Canada, which provides universal accessibility to medically necessary care.
Notes
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PubMed ID
19484796 View in PubMed
Less detail

Associations of physician supplies with colon cancer care in Ontario and California, 1996 to 2006.

https://arctichealth.org/en/permalink/ahliterature143134
Source
Dig Dis Sci. 2011 Feb;56(2):523-31
Publication Type
Article
Date
Feb-2011
Author
Kevin M Gorey
Isaac N Luginaah
Emma Bartfay
Karen Y Fung
Eric J Holowaty
Frances C Wright
Caroline Hamm
Sindu M Kanjeekal
Madhan K Balagurusamy
Author Affiliation
School of Social Work, University of Windsor, Windsor, ON, Canada. gorey@uwindsor.ca
Source
Dig Dis Sci. 2011 Feb;56(2):523-31
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
California
Colonic Neoplasms - therapy
Delivery of Health Care - organization & administration
Gastroenterology
Humans
Ontario
Physicians - supply & distribution
Urban Population
Abstract
This study examined the differential effects of physician supplies on colon cancer care in Ontario and California. The associations of physician supplies with colon cancer stage at diagnosis, receipt of surgery and adjuvant chemotherapy, and 5-year survival were observed within each country and compared between-country.
Random samples of Ontario and California cancer registries provided 2,461 and 2,200 colon cancer cases that were diagnosed between 1996 and 2000, and followed until 2006. Both registries included data on the stage of disease at the time of diagnosis, receipt of cancer-directed surgery, receipt of adjuvant chemotherapy, and survival. Census tract-level data on low-income prevalence were, respectively, taken from 2001 and 2000 Canadian and United States population censuses. County-level primary care physician and gastroenterologist densities were computed for the same years.
Significant income-adjusted, gastroenterologist density threshold effects (2.0 or more vs. less than 2.0 per 100,000 inhabitants) were observed for early diagnosis (OR = 1.57) and 5-year survival (OR = 1.63) in Ontario, but not in California. Significant incremental threshold effects of primary care physician densities on chemotherapy receipt (8.0 and 9.0 or more per 10,000 inhabitants, respective ORs of 1.79 and 2.37) were also only observed in Ontario.
These colon cancer care findings support the theory that while personal economic resources are more predictive in America, community-level resources such as physician supplies are more predictive of health care access and effectiveness in Canada.
Notes
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PubMed ID
20521113 View in PubMed
Less detail

Better colon cancer care for extremely poor Canadian women compared with American women.

https://arctichealth.org/en/permalink/ahliterature105274
Source
Health Soc Work. 2013 Nov;38(4):240-8
Publication Type
Article
Date
Nov-2013
Author
Kevin M Gorey
Isaac N Luginaah
Emma Bartfay
GuangYong Zou
Sundus Haji-Jama
Eric J Holowaty
Caroline Hamm
Sindu M Kanjeekal
Frances C Wright
Madhan K Balagurusamy
Nancy L Richter
Author Affiliation
School of Social Work, University of Windsor, Ontario, Canada. gorey@uwindsor.ca
Source
Health Soc Work. 2013 Nov;38(4):240-8
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
California
Canada
Colonic Neoplasms - economics - therapy
Cross-Cultural Comparison
Female
Healthcare Disparities - economics
Humans
Ontario
Quality of Health Care - economics
Registries - statistics & numerical data
Regression Analysis
Survival Analysis
United States
Abstract
Extremely poor Canadian women were recently observed to be largely advantaged on most aspects of breast cancer care as compared with similarly poor, but much less adequately insured, women in the United States. This historical study systematically replicated the protective effects of single- versus multipayer health care by comparing colon cancer care among cohorts of extremely poor women in California and Ontario between 1996 and 2011. The Canadian women were again observed to have been largely advantaged. They were more likely to have received indicated surgery and chemotherapy, and their wait times for care were significantly shorter. Consequently, the Canadian women were much more likely to experience longer survival times. Regression analyses indicated that health insurance nearly completely explained the Canadian advantages. Implications for contemporary and future reforms of U.S. health care are discussed.
PubMed ID
24432491 View in PubMed
Less detail

Breast cancer care in the Canada and the United States: ecological comparisons of extremely impoverished and affluent urban neighborhoods.

https://arctichealth.org/en/permalink/ahliterature147865
Source
Health Place. 2010 Jan;16(1):156-63
Publication Type
Article
Date
Jan-2010
Author
Kevin M Gorey
Isaac N Luginaah
Caroline Hamm
Karen Y Fung
Eric J Holowaty
Author Affiliation
School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor, Ontario, Canada N9B 3P4. gorey@uwindsor.ca
Source
Health Place. 2010 Jan;16(1):156-63
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Breast Neoplasms - drug therapy
California
Canada
Female
Healthcare Disparities
Humans
Middle Aged
Ontario
Poverty
Registries
Social Class
Survival
United States
Urban Population
Abstract
This study examined the differential effect of extreme impoverishment on breast cancer care in urban Canada and the United States. Ontario and California registry-based samples diagnosed between 1998 and 2000 were followed until 2006. Extremely poor and affluent neighborhoods were compared. Poverty was associated with non-localized disease, surgical and radiation therapy (RT) waits, non-receipt of breast conserving surgery, RT and hormonal therapy, and shorter survival in California, but not in Ontario. Extremely poor Ontario women were consistently advantaged on care indices over their California counterparts. More inclusive health insurance coverage in Canada seems the most plausible explanation for such Canadian breast cancer care advantages.
Notes
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PubMed ID
19840902 View in PubMed
Less detail

Breast cancer survival in ontario and california, 1998-2006: socioeconomic inequity remains much greater in the United States.

https://arctichealth.org/en/permalink/ahliterature152844
Source
Ann Epidemiol. 2009 Feb;19(2):121-4
Publication Type
Article
Date
Feb-2009
Author
Kevin M Gorey
Isaac N Luginaah
Eric J Holowaty
Karen Y Fung
Caroline Hamm
Author Affiliation
School of Social Work, University of Windsor, Ontario. gorey@uwindsor.ca
Source
Ann Epidemiol. 2009 Feb;19(2):121-4
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - economics - mortality
California - epidemiology
Female
Healthcare Disparities
Humans
Ontario - epidemiology
Poverty Areas
Social Class
Survival Analysis
Abstract
This study re-examined the differential effect of socioeconomic status on the survival of women with breast cancer in Canada and the United States. Ontario and California cancer registries provided 1,913 cases from urban and rural places. Stage-adjusted cohorts (1998-2000) were followed until 2006. Socioeconomic data were taken from population censuses. SES-survival associations were observed in California, but not in Ontario, and Canadian survival advantages in low-income areas were replicated. A better controlled and updated comparison reaffirmed the equity advantage of Canadian health care.
Notes
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Cites: Am J Epidemiol. 2002 Sep 1;156(5):471-8212196317
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PubMed ID
19185806 View in PubMed
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Canadian breast implant cohort: extended follow-up of cancer incidence.

https://arctichealth.org/en/permalink/ahliterature125120
Source
Int J Cancer. 2012 Oct 1;131(7):E1148-57
Publication Type
Article
Date
Oct-1-2012
Author
Sai Yi Pan
Eric Lavigne
Eric J Holowaty
Paul J Villeneuve
Lin Xie
Howard Morrison
Jacques Brisson
Author Affiliation
Public Health Agency of Canada, Ottawa, ON, Canada.
Source
Int J Cancer. 2012 Oct 1;131(7):E1148-57
Date
Oct-1-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Breast Implants - adverse effects
Breast Neoplasms - epidemiology
Canada - epidemiology
Cohort Studies
Female
Follow-Up Studies
Humans
Incidence
Middle Aged
Young Adult
Abstract
Cosmetic breast implants are not associated with increased breast cancer incidence, but variations of risk according to implant characteristics are still poorly understood. As well, the assessment of cancer risk for sites other than breast needs to be clarified. The purpose of this study was to fill these research gaps. This study presents an extended analysis of 10 more years of follow-up of a large Canadian cohort of women who received either cosmetic breast implants (n = 24,558) or other cosmetic surgery (15,893). Over 70% of the implant cohort was followed for over 20 years. Cancer incidence among implant women was compared to those of controls using multivariate Poisson models and the general female population using the standardized incidence ratios (SIRs). Women with breast implants had reduced rates of breast and endometrial cancers compared to other surgery women. Subglandular implants were associated to a reduced rate of breast cancer compared to submuscular implants [incidence rate ratio (IRR) = 0.78, 95% confidence interval (CI) = 0.63-0.96] and this reduction persisted over time. We observed a sevenfold increased rate (IRR = 7.36, 95% CI = 1.86-29.12) of breast cancer in the first 5 years after the date of surgery for polyurethane-coated subglandular implant women but this IRR decreased progressively over time (p value for trend = 0.02). We also observed no increased risk of rarer forms of cancer among augmented women. A reduction in breast cancer incidence was observed for women with subglandular implants relative to women with submuscular implants. Possible increase of breast cancer incidence shortly after breast augmentation with polyurethane implants needs to be verified.
PubMed ID
22514048 View in PubMed
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Cancer incidence in a cohort of Ontario and Quebec women having bilateral breast augmentation.

https://arctichealth.org/en/permalink/ahliterature171380
Source
Int J Cancer. 2006 Jun 1;118(11):2854-62
Publication Type
Article
Date
Jun-1-2006
Author
Jacques Brisson
Eric J Holowaty
Paul J Villeneuve
Lin Xie
Anne-Marie Ugnat
Louis Latulippe
Yang Mao
Author Affiliation
Department of Social and Preventive Medicine, Laval University, Laval, QC, Canada.
Source
Int J Cancer. 2006 Jun 1;118(11):2854-62
Date
Jun-1-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Breast Implants - adverse effects
Case-Control Studies
Cohort Studies
Female
Functional Laterality
Humans
Incidence
Middle Aged
Neoplasms - epidemiology
Ontario - epidemiology
Quebec - epidemiology
Risk factors
Silicones - adverse effects
Abstract
The possibility that women, who receive breast implants for cosmetic purposes, have increased long-term risks of developing cancer continues to be debated. The objective of our study was to prospectively examine cancer incidence among women who received breast implants. A cohort was assembled of 24,558 women, 18 years of age and older, who underwent bilateral cosmetic breast augmentation, and 15,893 women who underwent other cosmetic procedures in Ontario or Quebec between 1974 and 1989. These plastic surgery patients were selected from the same clinics as the implant population. Incident cancers were identified by linking to Canadian registry data up to December 31, 1997. In total, 676 cancers were identified among women who received breast implants compared to 899 expected based on general population rates (standardized incidence ratio (SIR) = 0.75; 95% confidence interval (CI) = 0.70-0.81). Overall cancer incidence rates among women who received breast implants were similar to that of the other plastic surgery patients (relative risk (RR) = 0.91, 95% CI = 0.81-1.02). However, women who received breast implants had lower breast cancer rates than the plastic surgery patients (RR = 0.64, 95% CI = 0.53-0.79). No increased risks were observed among the implant population for any of the other cancer sites examined. Comparisons involving only women who received breast implants found no association between long-term breast cancer incidence and implant site (submuscular vs. subglandular), fill (saline vs. silicone) or envelope (polyurethane-coated or not). In conclusion, women undergoing cosmetic breast augmentation do not appear to be at an increased long-term risk of developing cancer.
PubMed ID
16381020 View in PubMed
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Cancer survival in Ontario, 1986-2003: evidence of equitable advances across most diverse urban and rural places.

https://arctichealth.org/en/permalink/ahliterature157558
Source
Can J Public Health. 2008 Jan-Feb;99(1):12-6
Publication Type
Article
Author
Kevin M Gorey
Karen Y Fung
Isaac N Luginaah
Emma Bartfay
Caroline Hamm
Frances C Wright
Madhan Balagurusamy
Aziz Mohammad
Eric J Holowaty
Kathy X Tang
Author Affiliation
School of Social Work, University of Windsor, Windsor, ON, Canada. gorey@uwindsor.ca
Source
Can J Public Health. 2008 Jan-Feb;99(1):12-6
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - epidemiology - mortality
Female
Health Services Accessibility
Humans
Incidence
Income
Ontario
Registries
Rural Population - statistics & numerical data
Socioeconomic Factors
Universal Coverage
Urban Population - statistics & numerical data
Abstract
This study examined whether place and socio-economic status had differential effects on the survival of women diagnosed with breast cancer in Ontario during the 1980s and the 1990s.
The Ontario Cancer Registry provided 29,934 primary malignant breast cancer cases. Successive historical cohorts (1986-1988 and 1995-1997) were, respectively, followed until 1994 and 2003. Diverse places were compared: the greater metropolitan Toronto area, other cities, ranging in size from 50,000 to a million people, smaller towns and villages, and rural and remote areas. Socio-economic data for each woman's residence at the time of diagnosis were taken from population censuses.
Very small cities (6%) with populations between 50,000 and 100,000 were the only places where breast cancer survival had advanced less compared to the province as a whole. Income gradients began to appear, however, in larger cities. Urban residents in the lowest income areas were significantly disadvantaged compared to the highest income areas during the 1990s, but not during the 1980s.
This historical analysis of breast cancer survival evidenced remarkably equitable advances across nearly all of Ontario's diverse places. The most likely explanation for such substantial equity seems to be Canada's universally accessible, single-payer, health care system.
Notes
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PubMed ID
18435383 View in PubMed
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Do breast implants adversely affect prognosis among those subsequently diagnosed with breast cancer? Findings from an extended follow-up of a Canadian cohort.

https://arctichealth.org/en/permalink/ahliterature122078
Source
Cancer Epidemiol Biomarkers Prev. 2012 Oct;21(10):1868-76
Publication Type
Article
Date
Oct-2012
Author
Eric Lavigne
Eric J Holowaty
Sai Yi Pan
Lin Xie
Paul J Villeneuve
Howard Morrison
Jacques Brisson
Author Affiliation
Unité de Recherche en Santé des Populations, URESP, Centre de recherche FRSQ du Centre hospitalier affilié universitaire de Québec and Laval University, Quebec City, Quebec, Canada. elavigne@uresp.ulaval.ca
Source
Cancer Epidemiol Biomarkers Prev. 2012 Oct;21(10):1868-76
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Adult
Breast Implants - adverse effects
Breast Neoplasms - mortality - pathology
Canada - epidemiology
Cohort Studies
Female
Follow-Up Studies
Humans
Logistic Models
Neoplasm Staging
Prognosis
Proportional Hazards Models
Abstract
Cosmetic breast implants may impair the ability to detect breast cancers. The aims of this study were to examine whether implants and implant characteristics are associated with more advanced breast tumors at diagnosis and poorer survival.
Study population includes all invasive breast cancer cases diagnosed during follow-up of the large Canadian Breast Implant Cohort. A total of 409 women with cosmetic breast implants and 444 women with other cosmetic surgery were diagnosed with breast cancer. These women were compared for stage at diagnosis using multinomial logistic regression models. Cox proportional hazards regression models were used for breast cancer-specific mortality analyses. Comparisons were also conducted according to implant characteristics.
Compared with women with other cosmetic surgery, those with cosmetic breast implants had at later stage breast cancer diagnosis (OR of having stage III/IV vs. stage I at diagnosis: 3.04, 95% confidence interval (CI): 1.81-5.10; P
PubMed ID
22850806 View in PubMed
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