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J Clin Oncol. 2014 Jul 10;32(20):2133-41. doi: 10.1200/JCO.2013.53.0774. Epub 2014 Jun 2.

Barriers to immediate breast reconstruction in the Canadian universal health care system.

Author information

1
Toni Zhong, Christine B. Novak, David R. McCready, Stefan O.P. Hofer, and Jonathon C. Irish, University Health Network; Bret A. Beber, Women's College Hospital; Nancy N. Baxter, St Michael's Hospital; Toni Zhong, Jennica Platt, Brett A. Beber, Christine B. Novak, David R. McCready, Stefan O.P. Hofer, Jonathon C. Irish, and Nancy N. Baxter, University of Toronto; Kimberly A. Fernandes, Refik Saskin, Rinku Sutradhar, and Nancy N. Baxter, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. toni.zhong@uhn.ca.
2
Toni Zhong, Christine B. Novak, David R. McCready, Stefan O.P. Hofer, and Jonathon C. Irish, University Health Network; Bret A. Beber, Women's College Hospital; Nancy N. Baxter, St Michael's Hospital; Toni Zhong, Jennica Platt, Brett A. Beber, Christine B. Novak, David R. McCready, Stefan O.P. Hofer, Jonathon C. Irish, and Nancy N. Baxter, University of Toronto; Kimberly A. Fernandes, Refik Saskin, Rinku Sutradhar, and Nancy N. Baxter, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.

Abstract

PURPOSE:

To describe the population-based rates of immediate breast reconstruction (IBR) for all women undergoing mastectomy for treatment or prophylaxis of breast cancer in the past decade, and to evaluate geographic, institutional, and patient factors that influence use in the publically funded Canadian health care system.

METHODS:

This population-based retrospective cohort study used administrative data that included 28,176 women who underwent mastectomy (25,141 mastectomy alone and 3,035 IBR) between April 1, 2002, and March 31, 2012, in Ontario, Canada. We evaluated factors associated with IBR by using a multivariable logistic regression model with the generalized estimating equation approach.

RESULTS:

The population-based, age-adjusted IBR rate increased from 5.1 procedures to 8.7 in 100,000 adult women (43.7%; P < .001), and the increase was greatest for prophylactic mastectomy or therapeutic mastectomy for in situ breast cancer (78.6%; P < .001). Women who lived in neighborhoods with higher median income had significantly increased odds of IBR compared with mastectomy alone (odds ratio [OR], 1.71; 95% CI, 1.47 to 2.00), and immigrant women had significantly lower odds (OR, 0.59; 95% CI, 0.44 to 0.78). A patient had nearly twice the odds of receiving IBR when she was treated at a teaching hospital (OR, 1.84; 95% CI, 1.1 to 3.06) or at a hospital with two or more available plastic surgeons (OR, 2.01; 95% CI, 1.53 to 2.65). Patients who received IBR traveled significantly farther compared with those who received mastectomy alone (OR, 1.04; 95% CI, 1.02 to 1.05 for every 10 km increase).

CONCLUSION:

IBR is available to select patients with favorable clinical and demographic characteristics who travel farther to undergo surgery at teaching hospitals with two or more available plastic surgeons.

PMID:
24888814
DOI:
10.1200/JCO.2013.53.0774
[Indexed for MEDLINE]

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