Patterns in health care delivery systems for breast cancers in Isere (France-1995)

Background: Caring for cancer patients is expensive, warranting verificatio n that health care organization works in a satisfactory way. A first step o f this evaluation deals with the description of the pathway followed in the health care system by the patient. Methods: 671 breast cancer cases were diagnosed in Isere in 1995. According to the place where each treatment (surgery, chemotherapy, radiotherapy) wa s performed we described pathways for the patient, either entirely private, public or mixed. Characteristics of the patient (age, place of residence), of the disease (extent of disease, way of discovery) and of the physician (general practitioner specialist) might have influenced the choice of this pathway. We described and tested the distribution of these characteristics within the 3 groups using univariate analysis. Relative risk of being affec ted to the private pathway compared to the public one was computed, after a djusting for age, type of physician, extent of disease, way of discovery an d sanitary area, using a multivariate analysis (logistic regression). Results: In the department of Isere, the private pathway cared for 55% of b reast cancers, the public one 23% and the mixed one 19%. There was no prefe rential recruitment according to age, physician type, presence of metastasi s or of the rural or urban residence. In sanitary area number 5, characteri zed by an important attraction of the patients by the nearby department of Rhone, 41% of the patients were cared for the private pathway, compared to 63% in sanitary area 4, where most patients were treated in the main town o f Isere: Grenoble. After early breast cancer detection with mammography ins tead of breast cancer screening, probability of being cared for in the priv ate pathway was 2-fold higher (OR=2) than in the public one. Conclusion: In Isere department early breast cancer defection with mammogra phy is in favor of the private pathway. This is not true for physician type , neither for characteristics of the patient or extent of the disease. Fina lly, the distance to next department of oncology or radiotherapy plays a ma jor role.