# Urban Rural Differences in Breast Cancer in New Zealand
## 4 Discussion
\begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Groups** & \multicolumn{2}{c}{**5-Year (95\% CI)**} & \multicolumn{2}{c}{**10-Year (95\% CI)**} & \multicolumn{2}{c}{**Log Rank Test**} \\  & \multicolumn{2}{c}{**Breast cancer-specific survival**} & \multicolumn{2}{c}{**(\(p\)-Value)**} \\ Rural women & 86.6\% & (85.1\%–88.1\%) & 81.5\% & (79.6\%–83.4\%) & 0.211 \\ Urban women & 88.0\% & (87.3\%–88.7\%) & 82.5\% & (81.5\%–83.4\%) & \\ Rural Maori women & 78.3\% & (73.2\%–83.5\%) & 72.1\% & (65.8\%–78.5\%) & 0.072 \\ Urban Maori women & 84.1\% & (81.4\%–86.8\%) & 77.9\% & (74.2\%–81.5\%) & \\ Rural European women & 87.9\% & (86.3\%–89.4\%) & 82.7\% & (80.7\%–84.8\%) & 0.605 \\ Urban European women & 88.6\% & (87.8\%–89.4\%) & 83.0\% & (81.9\%–84.1\%) & \\ \hline \hline \multicolumn{4}{c}{**All-cause survival**} \\ Rural women & 80.6\% & (78.9\%–83.3\%) & 67.8\% & (65.4\%–70.2\%) & 0.007 \\ Urban women & 82.7\% & (81.9\%–83.4\%) & 71.2\% & (70.1\%–72.4\%) & \\ Rural Maori women & 71.6\% & (66.2\%–77.0\%) & 55.8\% & (48.2\%–63.3\%) & 0.017 \\ Urban Maori women & 77.9\% & (74.9\%–80.9\%) & 64.9\% & (60.6\%–69.2\%) & \\ Rural European women & 81.9\% & (80.0\%–83.7\%) & 69.0\% & (66.4\%–71.6\%) & 0.394 \\ Urban European women & 82.0\% & (81.1\%–83.0\%) & 70.3\% & (69.0\%–71.7\%) & \\ \hline \hline \end{tabular}  
* Adjusted for age, (ethnicity), cancer stage, tumour size, grade, hormonal status (ERPR), year of diagnosis, mode of detection and comorbidity.
* \(p\)-Value < 0.05.  
\end{table} 
Table 3: 5-year and 10-year breast cancer-specific survival and all-cause survival by Kaplan–Meier method. transport was a barrier--a key factor for rural women [14]. Access to primary care is important in that it has been shown that the more general practitioners per population, the earlier stage of diagnosis [15]. These findings are similar to those of our previous study using cancer registry data which showed no difference in stage or survival in rural women after adjustment for demographic factors. The screen detection rates in our rural women are re-assuring and suggest that our breast screening programs in Auckland and the Waikato are reaching rural women. The main concern is the overall lower rate in Maori women. These disparities are being addressed by Breast-screen Aoteoaroea. We have shown that rural Maori women can achieve high rates of breast screening if a concerted general practice based approach is taken to encouraging mammographic screening [16]. One of the factors that has been noted in Australia linked to poorer outcomes has been that rural women may be treated in a smaller centre by a low case load surgeon [17]. This is not a factor in our study as all women were treated in a high case load centre either in Auckland or Waikato. This may be one explanation for the lack of difference in overall outcomes. The strengths of this study are that it is based on data from complete and high quality registers which have been collected prospectively. The weakness is that the study is dominated by the high number of urban women and relatively small numbers of rural Maori (311) which mean the results relating to Maori are less stable than the remainder of the results.