Abstracts
Abstract
Healthcare inequalities among Australian Indigenous people are significantly influenced by sociocultural factors. Understanding these influences and potential solutions benefits from insights into behavioural factors in parallel with social and cultural perspectives of beliefs and attitudes. Deeper analysis of breast cancer among Indigenous women is required to better understand factors and solutions to close the inequality gap.
A systematic and critical review of peer-reviewed literature was undertaken using the MEDLINE (Pubmed) electronic database. After inclusion and exclusion criteria were applied, and critical appraisal undertaken, 20 articles were identified that aligned with breast cancer incidence or survival among Indigenous Australians.
The analysis revealed three central themes; pathological factors, cultural factors and social factors. Data linkage strategies reveals inequality in both incidence and 5-year survival for Indigenous breast cancer patients. Both sociocultural behaviours and sociocultural attitudes and beliefs about health, illness and healing contribute to inequality among Indigenous breast cancer patients.
Poorer outcomes relate to Indigenous patients presenting with more advanced disease. Cultural and socioeconomic behaviours, attitudes and beliefs are significant barriers that create disparities between Indigenous and non-Indigenous women’s access to and engagement with breast cancer services.
Keywords:
- Indigenous Australian,
- breast cancer,
- survival,
- incidence,
- inequality
Appendices
Bibliography
- Adams, J., Valery, P. C., Sibbritt, D., Bernardes, C. M., Broom, A., & Garvey, G. (2015). Use of traditional Indigenous medicine and complementary medicine among Indigenous cancer patients in Queensland, Australia. Integrative Cancer Therapies, 14(4), 359–365. https://doi.org/10.1177/1534735415583555
- Anderson, K., Diaz, A., Parikh, D.R., & Garvey, G. (2021). Accessibility of cancer treatment services for Indigenous Australians in the Northern Territory: perspectives of patients and care providers. BMC Health Serv Res, 28;21(1):95. https://doi.org/10.1186/s12913-021-06066-3
- Anderson, I., Robson, B., Connolly, M., Al-Yaman, F., Bjertness, E., King, A., et al. (2016). Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): A population study. The Lancet, 388(10040), 131–157. https://doi.org/10.1016/s0140-6736(16)32465-5
- Australian Institute of Health and Welfare (AIHW). (2014). Australia’s Health 2014. http://www.aihw.gov.au/australias-health/2014/indigenous-health/
- Australian Institute of Health and Welfare (AIHW). (2020). Aboriginal and Torres Strait Islander Health Performance Framework 2020 summary report. Cat. no. IHPF 2. Canberra: AIHW.
- Bainbridge, R., McCalman, J., Clifford, A., & Tsey, K. (2015). Australian Government. Cultural competency in the delivery of health services for Indigenous people. Issues paper no. 13 produced for the Closing the Gap Clearinghouse.
- Banham, D., Roder, D., Keefe, D., Farshid, G., Eckert, M., Howard, N., et al. (2019). Disparities in breast screening, stage at diagnosis, cancer treatment and the subsequent risk of cancer death: A retrospective, matched cohort of Aboriginal and non-Aboriginal women with breast cancer. BMC Health Services Research, 19(1), 387. https://doi.org/10.1186/s12913-019-4147-5
- Baum, S. (2023). Exploring disparities in breast cancer screening: An ecological analysis of Australian data. Asian Pacific Journal of Cancer Prevention, 24(12), 4139–4145. https://doi.org/10.31557/apjcp.2023.24.12.4139
- Carinci, F., Štotl, I., Cunningham, S. G., Poljicanin, T., Pristas, I., Traynor, V., et al. (2021). Making use of comparable health data to improve quality of care and outcomes in diabetes: The EUBIROD review of diabetes registries and data sources in Europe. Frontiers in Clinical Diabetes and Healthcare, 2, 744516. https://doi.org/10.3389/fcdhc.2021.744516
- Christie, V., Green, D., Amin, J., Pyke, C., Littlejohn, K., Skinner, J., et al. (2021). What is the evidence globally for culturally safe strategies to improve breast cancer outcomes for Indigenous women in high-income countries? A systematic review. International Journal of Environmental Research and Public Health, 18, 6073. https://doi.org/10.3390/ijerph18116073
- Christie, V., Rice, M., Dracakis, J., Green, D., Amin, J., Littlejohn, K., et al. (2022). Improving breast cancer outcomes for Aboriginal women: A mixed-methods study protocol. BMJ Open, 12(1), e048003. https://doi.org/10.1136/bmjopen-2020-048003
- Christie, V., Riley, L., Green, D., Snook, K., Henningham, M., Rambaldini, B., Amin, J., Pyke, C., Varlow, M., Goss, S., Skinner, J., O'Shea, R., McCowen, D., Gwynne, K. (2023a). Does breast cancer policy meet the needs of Aboriginal and Torres Strait Islander women in Australia? a review. Int J Equity Health, 22(1):129. https://doi.org/10.1186/s12939-023-01941-3
- Christie, V., Green, D., Skinner, J., Riley, L., O'Shea, R., Littlejohn, K., Pyke, C., McCowen, D., Rambaldini, B., & Gwynne, K. (2023b). "Everyone needs a Deb": what Australian indigenous women say about breast cancer screening and treatment services. BMC Health Serv Res, 23(1):672. https://doi.org/10.1186/s12913-023-09633-y
- Condon, J. R., Zhang, X., Dempsey, K., Garling, L., & Guthridge, S. (2016). Trends in cancer incidence and survival for Indigenous and non-Indigenous people in the Northern Territory. Medical Journal of Australia, 205(10), 454–458. https://doi.org/10.5694/mja16.00588
- Currie, G., Wheat, J., & Wess, T. (2018). Building foundations for Indigenous cultural competence: An institution’s journey toward “closing the gap.” Journal of Medical Imaging and Radiation Sciences, 49, 6–10.
- Currie, G. (2022). Yindyamarra winhanganha: A conduit to Indigenous cultural proficiency. Journal of Nuclear Medicine Technology, 50, 66–72.
- Currie, J., & Currie, G. (2022). Emotional intelligence and productive relationships with patients and colleagues. Journal of Nuclear Medicine Technology, 50, 357–365.
- Dasgupta, P., Baade, P.D., Youlden, D.R., Garvey, G., Aitken, J.F., Wallington, I., et al. (2017). Variations in outcomes for Indigenous women with breast cancer in Australia: a systematic review. Eur J Cancer Care (Engl), 26(6). https://doi.org/10.1111/ecc.12662
- 8 ways. (2011). 9 Aboriginal ways of learning. Aboriginal pedagogy. https://www.8ways.online/
- Garvey, G., Cunningham, J., He, V. Y., Janda, M., Baade, P., Sabesan, S., et al. (2016). Health-related quality of life among Indigenous Australians diagnosed with cancer. Quality of Life Research, 25(8), 1999–2008.
- Li, J. L. (2017). Cultural barriers lead to inequitable healthcare access for Aboriginal Australians and Torres Strait Islanders. Chinese Nursing Research, 4(4). https://doi.org/10.1016/j.cnre.2017.10.009
- Kerin, Ú. (2020). Women's experiences of breast cancer reveal the need for a holistic person-centred approach to breast cancer care. Evidence-Based Nursing, 23(1), 19. https://doi.org/10.1136/ebnurs-2019-103087
- McLean, K., Darcey, E., Cadby, G., Lund, H., Pilkington, L., Redfern, A., et al. (2019). The distribution and determinants of mammographic density measures in Western Australian Aboriginal women. Breast Cancer Research, 21(1), 33. https://doi.org/10.1186/s13058-019-1113-4
- McLennan, V., & Khavarpour, F. (2004). Culturally appropriate health promotion: Its meaning and application in Aboriginal communities. Health Promotion Journal of Australia, 15(3), 237–239.
- McMichael, C., Kirk, M., Manderson, L., Hoban, E., & Potts, H. (2000). Indigenous women's perceptions of breast cancer diagnosis and treatment in Queensland. Australian and New Zealand Journal of Public Health, 24(5), 515–519.
- Mencel, J., Hong, H. W., Charakidis, M., Pokorny, A., Aldridge, E., & Karanth, N. (2023). Breast cancer characteristics and pathological prognostic determinants in Indigenous Australians: Retrospective cohort study in the Northern Territory. Asia-Pacific Journal of Clinical Oncology. Advance online publication. https://doi.org/10.1111/ajco.13956
- Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., et al. (2025). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4(1), 1. https://doi.org/10.1186/2046-4053-4-1
- Moore, S. P., Antoni, S., Colquhoun, A., Healy, B., Ellison-Loschmann, L., Potter, J. D., et al. (2015). Cancer incidence in Indigenous people in Australia, New Zealand, Canada, and the USA: A comparative population-based study. The Lancet Oncology, 16(15), 1483–1492.
- Naeem, M., Ozuem, W., Howell, K., & Ranfagni, S. (2023). A Step-by-Step Process of Thematic Analysis to Develop a Conceptual Model in Qualitative Research. International Journal of Qualitative Methods, 22. https://doi.org/10.1177/16094069231205789
- Pilkington, L., Haigh, M.M., Durey, A., Katzenellenbogen, J.M., & Thompson, S.C. (2017). Perspectives of Aboriginal women on participation in mammographic screening: a step towards improving services. BMC Public Health, 17(1):697. https://doi.org/10.1186/s12889-017-4701-1
- Prior, D. (2005). Cultural strengths and social needs of Aboriginal women with cancer. PhD Thesis. The University of Queensland. https://espace.library.uq.edu.au/view/UQ:276999
- Prior, D. (2009). The meaning of cancer for Australian Aboriginal women; changing the focus of cancer nursing. Eur J Oncol Nurs, 13(4):280-286.
- Read, D.J., Frentzas, S., Ward, L., De Ieso, P., Chen, S., & Devi, V. (2020). Do histopathological features of breast cancer in Australian Indigenous women explain the survival disparity? A two decade long study in the Northern Territory. Asia Pac J Clin Oncol, 16(6):348-355.
- Reath, J., & Carey, M. (2008). Breast and cervical cancer in indigenous women-overcoming barriers to early detection. Aust Fam Physician, 37(3):178-182.
- Riley, T., Anderson, N. E., Lovett, R., Meredith, A., Cumming, B., & Thandrayen, J. (2021). One Health in Indigenous communities: A critical review of the evidence. International Journal of Environmental Research and Public Health, 18(21), 11303. https://doi.org/10.3390/ijerph182111303
- Shahid, S., Finn, L., Bessarab, D., & Thompson, S. C. (2009). Understanding, beliefs and perspectives of Aboriginal people in Western Australia about cancer and its impact on access to cancer services. BMC Health Services Research, 9, 132. https://doi.org/10.1186/1472-6963-9-132
- Shapiro, J., Lie, D., Gutierrez, D., & Zhuang, G. (2006). “That never would have occurred to me”: A qualitative study of medical students' views of a cultural competence curriculum. BMC Medical Education, 6(1).
- Stephens, C., Nettleton, C., Porter, J., Willis, R., & Clark, S. (2005). Indigenous peoples' health – why are they behind everyone, everywhere? The Lancet, 366(9479). https://doi.org/10.1016/s0140-6736(05)66801-8
- Tapia, K.A., Garvey, G., Mc Entee, M., Rickard, M., & Brennan, P. (2017). Breast Cancer in Australian Indigenous Women: Incidence, Mortality, and Risk Factors. Asian Pac J Cancer Prev, 18(4):873-884.
- Tapia, K.A., Garvey, G., McEntee, M.F., Rickard, M., Lydiard, L., & Brennan, P.C. (2019). Breast screening attendance of Aboriginal and Torres Strait Islander women in the Northern Territory of Australia. Aust N Z J Public Health, 43(4):334-339.
- Tervonen, H. E., Walton, R., You, H., Baker, D., Roder, D., Currow, D., et al. (2017). After accounting for competing causes of death and more advanced stage, do Aboriginal and Torres Strait Islander peoples with cancer still have worse survival? A population-based cohort study in New South Wales. BMC Cancer, 17(1), 398. https://doi.org/10.1186/s12885-017-3374-6
- Tervonen, H.E., Morrell, S., Roder, D., You, H., & Currow, D.C. (2019a). Differences in cancer incidence by age at diagnosis between Aboriginal and non-Aboriginal people for cancer types included in Australian national screening programs. Cancer Epidemiol, 60:102-105.
- Tervonen, H. E., Purdie, S., & Creighton, N. (2019). Using data linkage to enhance the reporting of cancer outcomes of Aboriginal and Torres Strait Islander people in NSW, Australia. BMC Medical Research Methodology, 19(1), 245. https://doi.org/10.1186/s12874-019-0884-8
- Ung, O. A. (2022). Towards better breast cancer outcomes for Indigenous populations in high-income countries with highly developed health systems. World Journal of Surgery, 46(3), 622–623.
- Valery, P. C., Coory, M., Stirling, J., & Green, A. C. (2006). Cancer diagnosis, treatment, and survival in Indigenous and non-Indigenous Australians: A matched cohort study. The Lancet, 367(9525), 1842–1848.
- Verbunt, E., Luke, J., Paradies, Y., Bamblett, M., Salamone, C., Jones, A., et al. (2021). Cultural determinants of health for Aboriginal and Torres Strait Islander people – a narrative overview of reviews. International Journal for Equity in Health, 20(1), 181. https://doi.org/10.1186/s12939-021-01514-2
- Walpole, E. T., Youl, P. H., Moore, J., Morris, M., Cossio, D., Dhanda, P., Theile, D. E., & Philpot, S. (2023). Development of a key performance indicator for breast cancer in Queensland, Australia. Breast Cancer Research and Treatment, 197(1), 211–221.
- Webb, C., Jacox, N., & Temple-Oberle, C. (2019). The making of breasts: Navigating the symbolism of breasts in women facing cancer. Plastic Surgery (Oakville), 27(1), 49–53.
- Wieman, N., & Malhotra, U. (2023). “Two eyed seeing”—embracing both Indigenous and Western perspectives in healthcare. BMJ, 383, p2614. https://doi.org/10.1136/bmj.p2614
- Youl, P. H., Dasgupta, P., Youlden, D., Aitken, J. F., Garvey, G., Zorbas, H., et al. (2016). A systematic review of inequalities in psychosocial outcomes for women with breast cancer according to residential location and Indigenous status in Australia. Psycho-Oncology, 25(10), 1157–1167.
- Youl, P. H., Aitken, J. F., Turrell, G., Chambers, S. K., Dunn, J., Pyke, C., et al. (2016). The impact of rurality and disadvantage on the diagnostic interval for breast cancer in a large population-based study of 3202 women in Queensland, Australia. International Journal of Environmental Research and Public Health, 13(11), 1156. https://doi.org/10.3390/ijerph13111156