Socio-economic disparities in access to treatment and their impact on colorectal cancer survival.

BACKGROUND: Significant socio-economic disparities have been reported in survival from colorectal cancer in a number of countries, which remain largely unexplained. We assessed whether possible differences in access to treatment among socio-economic groups may contribute to those disparities, using a population-based approach. METHODS: We retrospectively studied 71 917 records of colorectal cancer patients, diagnosed between 1997 and 2000, linked to area-level socio-economic information (Townsend index), from three cancer registries in UK. Access to treatment was measured as a function of delay in receipt of treatment. We assessed socio-economic differences in access through logistic regression models. Based on relative survival < or =3 years after diagnosis, we estimated excess hazard ratios (EHRs) of death for different socio-economic groups. RESULTS: Compared with more affluent patients, deprived patients had poorer survival [EHR = 1.20; 95% confidence interval (CI) 1.16-1.25], were less likely to receive any treatment within 6 months [odds ratio (OR) = 0.87, 95% CI 0.82-0.92] and, if treated, were more likely to receive late treatment. No disparities in survival were detected among patients receiving treatment within 1 month from diagnosis. Disparities existed among patients receiving later or no treatment (EHR = 1.30; 95% CI 1.22-1.39), and persisted after adjustment for age and stage at diagnosis (EHR = 1.15; 95% CI 1.08-1.24). CONCLUSIONS: Tumour stage helped explain socio-economic disparities in colorectal cancer survival. Disparities were also greatly attenuated among patients receiving early treatment. Aspects other than those captured by our measure of access, such as quality of care and patient preferences in relation to treatment, might contribute to a fuller explanation

Risk factors for breast cancer by age and menopausal status: A case-control study in Singapore

10.1007/BF00146884Cancer Causes and Control34313-322CCCN

Do lifestyle or social factors explain ethnic/racial inequalities in breast cancer survival?

Despite numerous studies documenting ethnic inequalities in breast cancer survival between minority and majority ethnic groups worldwide, reasons for these inequalities remain unclear. The authors performed a systematic review of published literature to identify studies that investigated the explanatory power of smoking, alcohol consumption, body mass index (BMI), and socioeconomic position (SEP) on ethnic inequalities in breast cancer survival. Sixteen studies were included in the review. From 5 studies, the authors found that differences in breast cancer survival between ethnic groups may be in part explained by BMI, but there was little evidence to implicate smoking or alcohol consumption as explanatory factors of this inequality. From 12 studies, the authors found that SEP explains part of the ethnic inequality in all-cause survival but that it was not evident for breast-cancer-specific survival. SEP explains more of the disparities among African-American versus white women in the United States compared with other ethnic comparisons. Furthermore, given social patterning of BMI and other lifestyle habits, it is possible that results for SEP and BMI are measuring the same effect. In this review, the authors make suggestions regarding the role of epidemiology in facilitating further research to better inform the development of effective policies to address ethnic differences in survival

Weaving ways of knowing to enhance biocultural resilience in a mahinga kai species-at-risk

The futures of many threatened species rest on our collective efforts to reweave the biological, cultural, and linguistic threads that together comprise biocultural diversity. For Western researchers, there is growing recognition that Indigenous Peoples and local communities are at the forefront of place-based approaches that bring together diverse ways of knowing and seeing. Here in Aotearoa New Zealand, these include restoration efforts led by mana whenua tribal groups with local authority to weave Māori—the Indigenous Peoples of Aotearoa New Zealand—knowledge, practices, and processes with Western science. For example, genomic markers offer a unique lens to explore relationships across populations, and in turn, co-develop management programmes that build resilience in threatened species. A growing number of studies are applying genomic data to enhance conservation outcomes, but few have tapped into their full potential by weaving these data with Indigenous and local relationships of place. This thesis represents the collective efforts of many—including whānau extended families, researchers, and practitioners, many of whom affiliate to the local iwi tribe, Ngāi Tahu—led here by a Pākehā (New Zealander of European settler descent) researcher. The recent application of genomic tools by Western-trained researchers to address conservation issues (i.e., conservation genomics) presents both opportunities and challenges for efforts to restore biocultural diversity. This thesis seeks to consider such complexities, including how genomic data might be better understood through a multiplicity of worldviews. Chapter Two serves to frame the research narrative of this thesis through a Perspective published in People and Nature’s joint special issue on informing decision-making with Indigenous and local knowledge and science. Few published conservation translocations (i.e., movement of animals or plants for conservation benefit) are led or co-led by Indigenous Peoples or centre Indigenous knowledge systems. As Kāi Tahu and Pākehā researchers and practitioners working in partnership in Aotearoa New Zealand, we consider how conservation translocations that weave diverse ways of knowing and seeing can enhance species recovery and build ecosystem resilience. We highlight the co-development of conservation translocations with Te Kōhaka o Tūhaitara and Te Nohoaka o Tukiauau Trusts where we are weaving emerging genomic approaches with mātauraka Māori Māori knowledge systems to recover culturally significant freshwater species. We further offer a Two-Eyed Seeing framework to support the co- design of conservation translocations led or co-led by Indigenous researchers and communities around the world. Chapter Three extends the narrative introduced in Chapter Two by focusing on the caveats of interpreting genomic data without local historical or contemporary context; namely, the movement or management of culturally significant species by Indigenous Peoples and local communities (IPLCs) in the distant or recent past. This Perspective brings together Kāi Tahu and Pākehā researchers and practitioners with expertise across customary and contemporary mahika kai food gathering (i.e., including processes, practices, and places), conservation genomics, ecology, fish biology, and aquaculture. To date, few efforts to characterise genetic variation within and between populations consider how human relationships with place may shape present-day species distributions. Yet, the movement of species by Indigenous and local communities in the distant and recent past provides important context for the interpretation of genomic data. For example, freshwater kōura1 crayfish in subalpine streams alongside ancient walking trails in Te Waipounamu (the South Island of Aotearoa New Zealand) were moved between sites to provide readily accessible food for travellers. We reflect on how weaving diverse ways of knowing and seeing can better reveal the biocultural complexities of genomic data derived from culturally significant species such as kōura, including locally adaptive variation. In Chapter Four, we shift focus to a research partnership with aquaculture company KEEWAI, mana whenua, and Te Rūnanga o Ngāi Tahu (TRoNT). This chapter reflects on the benefits, risks, and outstanding questions around genetic rescue (i.e., the introduction or restoration of new genetic material to small, isolated populations to reduce genetic load). We present experimental co-design and preliminary genomic data as proof-of-concept for a series of kōura translocation experiments at the KEEWAI aquaculture ponds ultimately intended to grow our understanding of the genetic mechanisms underlying genetic rescue. These data contribute toward the foundation and development of a multi-generational research programme that will support tribal-led aquaculture initiatives for kōura and other mahika kai species across the Kāi Tahu takiwā tribal territory. The research partnerships and approaches described above are brought together in Chapter Five to explore contemporary and historical relationships across kēkēwai1 freshwater crayfish populations in Te Waipounamu by weaving genomic data with placed-based knowledges. Genomic data reveal strong population genetic structure—as well as signatures of population admixture—across seventeen genetically depauperate populations in Te Waipounamu. Differentiation and environment association analyses further identify patterns of genetic variation linked to hydroclimatic variables, including temperature, precipitation, and water flow regimes. We consider how weaving these data with place-based knowledges can enhance resilience in kēkēwai through tribal-led initiatives for mahika kai. Our findings further contribute toward a growing understanding of how adaptive and neutral genetic variation shape threatened species’ capacity to respond to future change. Finally, Chapter Six critically reflects on the journey of this thesis and future directions, including tribal-led research programmes that will strengthen the relationships between people and mahika kai to build intergenerational capacity for protecting biocultural heritage. Two additional manuscripts, three blogs and an example summary for mana whenua are also included in the appendices. Together, these works contribute toward reconnection to place and the growth of our collective knowledge for treasured species in Aotearoa New Zealand and beyond