Population‐based picture of breast reconstruction in Queensland, Australia

Abstract

Background Approximately 40% of women with invasive breast cancer will undergo a mastectomy. Clinical practice guidelines recommend breast reconstruction (BR) options should be discussed with all women who are to undergo a mastectomy. We sought to examine rates of BR, BR methods over time and to identify factors associated with the likelihood of receiving BR in Queensland. Methods This population‐based study used linked data from the Queensland Oncology Repository for 12 364 women who underwent a mastectomy for invasive breast cancer from 2008 to 2017. Multivariate logistic regression was used to model predictors of immediate breast reconstruction (IBR) and delayed breast reconstruction (DBR). Results Overall, 2560 (20.7%) women had BR, with 9.8% having IBR and 10.9% having DBR. Factors associated with a reduced likelihood of IBR or DBR included older age (P < 0.001), living in a regional/rural area (P < 0.001) and having a mastectomy in a public versus private hospital (P < 0.001). Median time from mastectomy to DBR was 18.4 and 29.2 months for women attending a private versus public hospital, respectively (P < 0.001). Use of implant‐based BR increased significantly with a corresponding decrease in autologous BR over time. Conclusions Significant disparities exist in rates of BR between public and private hospitals. Women living in regional and rural areas as well as those aged over 60 years continue to have lower rates of BR. Addressing the health system barriers and developing strategies to improve access to, and uptake of BR should be a priority.

Trends and variations in post‐mastectomy breast reconstruction rates in Australia over 10 years

“…The BR rate of NSW in 2019 was 33.2% which is a significant improvement compared to the previously reported rate of 17.1% in a state‐based NSW study between 2012 to 2015. A BR rate of 20.7% was found in a Queensland‐based study using the Queensland Oncology Repository from 2008 to 2017 11 . This BR rate is higher than our finding of 19.9% in 2019 because it likely includes both IBR and additionally DBR completed by plastic and reconstructive surgeons, which is not completely captured in the BQA database.…”

“…As previously stated, the nature of the BQA data collection means nearly all these cases would be IBR. Other sources suggest that perhaps another 10% of women having mastectomy have DBR 11 . The BQA reported yearly BR rate steadily increased from 12.8% in 2010 to 29% in 2019.…”

Uptake of breast reconstruction following mastectomy: a Gold Coast experience

“…1,3,4 In Australia, data demonstrate that women who are older, from low socio-economic or rural areas were less likely to have BR. 1,10,11 Reasons for declining BR included the perception of lower complication rates with simple mastectomies alone (35%), preference to avoid a foreign body (40%) or feeling that reconstruction was not important for their body image (51%). 12 This was possibly due to feelings of scepticism towards health care systems, reservations about implants and influences of spiritual or cultural factors on decision-making.…”

“…Barriers to reconstruction include age, ethnicity, tumour characteristics, need for adjuvant radiation therapy, income, access including geographical location, surgeon availability and skill 1,3,4 . In Australia, data demonstrate that women who are older, from low socio‐economic or rural areas were less likely to have BR 1,10,11 . Reasons for declining BR included the perception of lower complication rates with simple mastectomies alone (35%), preference to avoid a foreign body (40%) or feeling that reconstruction was not important for their body image (51%) 12 .…”

Quantifying the Costs to Different Funders over Five-Years for Women Diagnosed with Breast Cancer in Queensland, Australia: A Data Linkage Study

“…Research indicates that, due to the mixed public-private healthcare system in Australia, there is potential for ‘cream skimming’, whereby the private sector provides high profit treatment options such as radiotherapy and/or surgery while transferring complex patients back into the public sector [ 31 ]. In support of this, research indicates that costly procedures such as immediate breast reconstruction following a mastectomy are more likely to be carried out in private hospitals [ 32 ]. This pattern of care be particularly evident through the high average costs identified within private hospitals in the first six months post-diagnosis in this study, where people diagnosed with breast cancer are accessing expensive treatment options in private healthcare facilities to skip the waiting lists that may occur within public hospitals.…”