Document Type

Article

Publication Date

2010

Publication Title

Health & Place

Volume

16

Issue

1

First Page

156

Last Page

163

DOI

10.1016/j.healthplace.2009.09.011

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.