Patterns of immediate breast reconstruction in New South Wales, Australia: a population‐based study

Abstract

BackgroundThe rate of immediate breast reconstruction (IBR) following mastectomy for breast cancer in Australia is low and varies between regions. To date, no previous Australian studies have examined IBR rates between all hospitals within a particular jurisdiction, despite hospitals being an important known contributor to variation in IBR rates in other countries.MethodsWe used cross‐classified random‐effects logistic regression models to examine the inter‐hospital variation in IBR rates by using data on 7961 women who underwent therapeutic mastectomy procedures in New South Wales (NSW) between January 2012 and June 2015. We derived IBR rates by patient‐, residential neighbourhood‐ and hospital‐related factors and investigated the underlying drivers for the variation in IBR.ResultsWe estimated the mean IBR rate across all hospitals performing mastectomy to be 17.1% (95% Bayesian credible interval (CrI) 12.1–23.1%) and observed wide inter‐hospital variation in IBR (variance 4.337, CrI 2.634–6.889). Older women, those born in Asian countries (odds ratio (OR) 0.5, CrI 0.4–0.6), residing in neighbourhoods with lower socioeconomic status (OR 0.7, CrI 0.5–0.8 for the most disadvantaged), and who underwent surgery in public hospitals (OR 0.4, CrI 0.1–1.0) were significantly less likely to have IBR. Women residing in non‐metropolitan areas and attending non‐metropolitan hospitals were significantly less likely to undergo IBR than their metropolitan counterparts attending metropolitan hospitals.ConclusionWide inter‐hospital variation raises concerns about potential inequities in access to IBR services and unmet demand in certain areas of NSW. Explaining the underlying drivers for IBR variation is the first step in identifying policy solutions to redress the issue.

Determinants influencing immediate breast reconstruction in an Australian tertiary public hospital

“…Breast cancer in Australia is a common disease, representing 28% of all cancers affecting women 1 . Research suggests that 40% of women diagnosed with breast cancers are treated with mastectomy, 2,3 a procedure that can cause a significant grief process for many women 4 . It is well recognized that immediate breast reconstruction (IBR) promotes self‐esteem and psychological health, whilst providing safe oncological outcomes 5,6 .…”

General practitioners are key to increasing Australia’s low rate of breast reconstruction

“…The most recent estimate of Australia's rate of breast reconstruction is 17-18%. 1,7 This rate is lower than that of similar health systems such as the UK, for which the rate is 23.3%. 8 Some specialist Australian centres that are committed to offering breast reconstruction to all suitable patients (both public and private) have reported immediate reconstruction rates of more than 40%, whereas one-third of 104 metropolitan hospitals that performed mastectomy in 2013 did no breast reconstruction.…”

Provision of breast reconstruction services in Australia: the case for change

“…As we write this, the COVID-19 fatality is 108. 4 The daily increase in cases initially peaked at 469 on 28 March, and the curve effectively flattened for the following months. However, subsequent resurgences of cases have occurred with a shift from overseas transmission to community transmission.…”