orals COSA Annual Scientific Meeting 2013

Patterns of Breast Cancer Care in Victoria: A joint Breast Cancer Quality Project. (#74)

Georgina Prassas 1 , Simone Alford 2 , Ying Chen 3 , Victoria White 4 , Helen Farrugia 4 , Christopher Hamilton 5
  1. Melbourne Health, Melbourne, Victoria, Australia
  2. Radiation Oncology, Austin Health, Melbourne, Victoria, Australia
  3. Victorian Data Linkages, Department of Health, Melbourne, Victoria, Australia
  4. Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
  5. Radiation Oncology, Austin Health, Melbourne, Victoria, Australia

Aims

Several overseas publications have reported recent changes in the rate of mastectomy for invasive breast cancer (1-6). We sought to identify any variation in breast cancer management in Victoria via a linkage between the Victorian Admitted Episode Dataset (VAED) and the Victorian Cancer Registry (VCR).

Methods

A retrospective cohort study was performed on 29,422 female patients registered in the VCR, with a diagnosis of primary (invasive) breast cancer within the study timeframe (4January 2000 to 31 December 2010). Socio-demographic and clinico-pathologic features were assessed for their impact on primary surgery, chemotherapy, and breast reconstruction.

Results

There were 26,554 women who underwent a definitive local procedure (DLP). The first DLP was mastectomy in 8,817 women. Of these, 8,145 underwent a unilateral mastectomy and 672 underwent a bilateral mastectomy. The DLP was wide local excision (WLE) in 17,737 women. The 90-day mastectomy rate was 38% in 2000 and 40% in 2010. Two hundred and ninety-seven women (1.1%) underwent a contra-lateral ‘prophylactic’ mastectomy. The mean length of stay was 4.1 days for mastectomy and 3.2 days for WLE. Adjuvant chemotherapy was administered to 5,298 women (19%). Neo-adjuvant chemotherapy (NACT) was administered to 534 women (1.9%). Following NACT, 406 women had a mastectomy (70.0% of DLPs).  Axillary clearance as a percentage of first DLP, declined over the study timeframe, from 80% in 2000 (n=1,418) to 37% in 2010 (n=935). In total, 2,078 women had 3,574 admissions for definitive or staged breast reconstruction procedures. Bilateral mastectomy increased from a total of 145 admissions in 2000 to 549 admissions in 2010.

Conclusions

We conclude that the 90-day mastectomy rate remained constant between 2000 and 2010. The use of chemotherapy (adjuvant and neo-adjuvant), breast reconstruction, and bilateral mastectomy increased markedly, and the use of axillary clearance decreased over the study timeframe. 

  1. McGuire KP, Santillan AA, Kaur P, et al. Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol. 2009; 16: 2682-90.
  2. Sorbero MES, Dick AW, Beckjord EB, Ahrendt G. Diagnostic Breast Magnetic Resonance Imaging and Contralateral Prophylactic Mastectomy. Ann Surg Oncol. 2009; 16: 1597-1605.
  3. Katipamula R, Degnim AC, Hoskin T, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: Effect of surgical Year and Preoperative Magnetic Resonance Imaging. J Clin Oncol. 2009; 27: 4082- 88.
  4. Morrow M, Harris JR. More mastectomies: Is this what patients really want? J Clin Oncol. 2009; 27: 4038- 4040.
  5. Balch CM, Jacobs LK. Mastectomies on the rise for breast cancer: “The tide is changing”. Ann Surg Oncol. 2009; 16: 2669-2672.
  6. Habermann EB, Abbott A, Parsons H, et al. Are mastectomy rates really increasing in the United States? J Clin Oncol. 2010; 28: 3437-3440.