Healthcare access and healthcare pathways for breast cancer : the example of the region of Paris

Breast cancer is the most frequent cancer for women in France. It has now been demonstrated that the risk factors for reporting and dying from this cancer, for participating in screening and prevention programs as well as for accessing quality care, depend on social characteristics. The existence of geographical disparities in incidence, screening participation and mortality has also been documented, depending on where women live. The objective of this research is to analyse the construction of inequalities in access to care during the period of the breast cancer healthcare pathway, in the vast urban area of the region of Paris (France). This is the first research in health geography to simultaneously question the roles of the individual characteristics of women (recorded in the anonymized databases of the French Health Insurance) and the urban dynamics specific to their residential environment, in the genesis of the inequality process in the treatment of breast cancer. The results highlight spatial disparities in the treatment sequences of women treated for invasive cancer. Other disparities also exist for access to surgical innovation, out-of-pocket expenses and delays in access to adjuvant treatment. Finally, our results show the existence of geographical inequalities in access to supportive care and quality of life during the healthcare pathway of breast cancer, when women reside far from the care centre and are cared for the entire healthcare pathway in this hospital.