Immediate Breast Reconstruction in Alberta: A Canadian Perspective
Jill P. Stone, MD, FRCSC1, Samuel Sarmiento, MD2, Jingyu Bu, BS1, Deepa Bhat, MD2, Claire Temple-Oberle, MD, MSc, FRCSC1.
1University of Calgary, Calgary, AB, Canada, 2Johns Hopkins University, Baltimore, MD, USA.
PURPOSE: The aim of this study is to assess the variations in immediate breast reconstruction (IBR) in the province of Alberta, Canada. More specifically, we sought to determine the rate of IBR and to understand the wait time differences that exist between urban and rural hospital settings and trends in reconstruction type.
METHODS: A patient database was created using a provincial cancer registry database cross referenced with the National Ambulatory Care Reporting System and the Discharge Abstract Database. Appropriate mastectomy and breast reconstruction codes were identified using procedure codes outlined in the Canadian Classification of Health Interventions. Women diagnosed with ductal carcinoma in situ or invasive carcinomas between the fiscal years 2005-2015 were included. Immediate breast reconstruction patients were then identified and patient demographic data, breast reconstruction details, and geographical information were obtained. Rural and urban populations were defined using Canada Statistical Guidelines for further analysis.
RESULTS: In the ten-year time period examined, 9,373 breast cancer patients underwent mastectomy in Alberta. There were 1,568 (16.7%) patients with delayed reconstruction, 547 (5.8%) patients with immediate reconstruction and 7,258 (77.5%) patients without breast reconstruction. Compared to women not undergoing reconstruction, IBR patients were significantly younger (48.4 vs. 62.7, p<0.001). Fewer women undergoing IBR required RT (60/547, 11.0%) compared to women who did not undergo reconstruction (2166/7258, 29.8%, p<0.001) and AJCC staging tended to be lower in women undergoing IBR . There were 76 (2.8%) women living in rural and 471 (6.7%) in urban areas who underwent IBR. Average age of rural and urban women were similar (49.1 vs. 48.3, p=0.05). Time from breast cancer diagnosis to mastectomy and reconstruction was an average of 14.7 for rural women vs. 14.5 weeks for urban women (p=0.9) and both waited similar times for flap or implant-based reconstruction. In relation to type, implant-based reconstruction was more common in both patient populations (p<0.01).
CONCLUSION: Differences in breast reconstruction patterns based on demographic factors have been described in the literature. This study of a large North American patient population highlights such differences. Younger women with better prognostic factors who live in urban settings have higher rates of immediate breast reconstruction. Knowledge of this can help us to mitigate these disparities by improving access to immediate breast reconstruction for certain populations.
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