Original articleDocumenting patterns of breast reconstruction in Australia: The national picture
Introduction
Having the option of breast reconstruction (BR) has a positive impact on women with breast cancer [1], [2], [3]. Findings from a systematic review of international studies suggested that around 50% of women who are offered BR would take up the offer [4]. Although a range of problems with data collection coverage and procedure identifiers preclude a reliable estimate of BR prevalence and distribution [5], BR rates in Australia are known to be low and highly variable. National estimates remain around 12% [6], [7], while some specialist breast centres in Australia report rates over 40% [8]. Interrogation of the Australian Institute of Health and Welfare & Cancer Australia data from 2009 to 2010 [9] revealed an estimated BR rate of 16% [5]. These Australian figures compare with estimates of 21% in the United Kingdom (UK) [10] and 26% in the United States of America (USA) [11].
The value of BR in women who have undergone mastectomy for breast cancer has been recognised in clinical recommendations from Australia [12], Europe [13], the USA [14] and the UK [15]. Causes of suspected variations require further investigation [7] to promote equitable access to BR services. Accurate and timely information is needed to enable national planning of BR services.
Section snippets
Materials and methods
Using 12 months of data (January–December 2013) from the Breast Surgeons of Australia and New Zealand Incorporated (BreastSurgANZ) Quality Audit (BQA) database [16] and geo-spatial software, we documented BR procedures across Australia. Data on the number of BR procedures were obtained for each of the 185 hospitals where the 250 Australian full members of BreastSugANZ were involved in the management of 3786 women having mastectomy for early stage breast malignancy—ductal carcinoma in situ
Breast reconstruction rates
Table 1 shows the reconstruction rate, based on the BQA data, for each of the six states and two territories and nationally. It demonstrates the significant variation between jurisdictions. However, these results need to be interpreted carefully, as the two territories and Tasmania have small numbers of BR patients. The national BR rate for women treated by BreastSurgANZ surgeons is 18.3%. Differences in BR rates between jurisdictions was significant: χ2 (df = 7) = 284.29, p < .001.
National distribution of BR services
The majority
Discussion
Overall this study methodology revealed a national BR rate of 18.3%, but there is significant variation between jurisdictions, across the age groups of patients, between public and private hospitals and between ARIA+ locations. Our findings have policy and practice implications for surgeons and governments.
The significant differences in uptake of BR in older women do not simply reflect the smaller numbers of these women having mastectomy. Women aged 65–69 have a 9.2% BR rate, compared to 2.6%
Conclusion
This research has provided the best available baseline quantitative data which documents the evidence on prevalence and distribution of BR in Australia, the first step towards a systematic and thorough review of existing disparities in service provision. As BR has been shown to provide long-term survivorship benefits for the growing number of women living longer following mastectomy for breast cancer, there is an urgent need to ensure BR is accessible and affordable for all women who choose
Ethics approval
Ethics approval was granted from St Vincent's Hospital, Sydney Human Research Ethics Committee (14/181) as part of the Improving Breast Reconstruction Equity of Access through Stakeholder consultation and Translation into policy and practice (I-BREAST) project.
Funding source
This mapping project has been generously funded by The Friends of the Mater Foundation, The Mater Hospital, Sydney, Australia. This study sponsor had no involvement in the study design, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
Notes
Data has been restricted to female mastectomy procedures performed during 2013, and subsequent BR on this same cohort of women performed either as immediate procedures in 2013, or delayed procedures in 2014. Patient postcodes were matched to ABS 2011 Postal Areas which are an approximation of Australia Post postcodes. Fourteen records were unable to be matched to a postal area or hospital and were excluded from the analysis. Hospital locations were sourced from the Department of Health
Conflict of interest statement
All authors declare they have no financial or personal relationships with other people or organisations that could inappropriately influence (bias) their work.
Acknowledgements
Data was supplied by BreastSurgANZ from the BQA (the interpretation and reporting of these data are the responsibility of the authors). Data analysis and mapping was conducted by Mr Jarrod Lange from the Australian Population and Migration Research Centre, The University of Adelaide, incorporating GISCA – The National Centre for Social Applications of Geographic Information Systems (GIS).
References (25)
- et al.
Uptake and predictors of post-mastectomy reconstruction in women with breast malignancy: systematic review
Eur J Surg Onc
(2013) - et al.
Factors predictive of immediate breast reconstruction following mastectomy for invasive breast cancer in Australia
Breast
(2013) - et al.
Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England
Plast Reconstr Aesthet Surg
(2014) - et al.
The requirements of a specialist Breast Centre
Eur J Cancer
(2013) - et al.
Patterns and outcomes of breast reconstruction in older women – a systematic review of the literature
Eur J Surg Oncol
(2016) National mastectomy and breast reconstruction audit (Report 2)
(2009)- et al.
Surgical decision-making in immediate breast reconstruction
World J Surg
(2010) Breast reconstruction after surgery for breast cancer
New Eng J Med
(2008)- et al.
The difficulties of sourcing Australian health data: the case of breast reconstruction
ANZ J Surg
(2016) National breast cancer audit – public health monitoring report on 2007 data
(March 2009)
Increasing breast reconstruction rates by offering more women a choice
ANZ J Surg
Breast cancer in Australia: an overview. Cancer series no. 71. Cat. No. CAN 67
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