Surgical and radiotherapy patterns of care in the management of breast cancer in NSW and ACT Australia

Abstract

Introduction This study aims to report on the surgical and radiotherapy patterns of breast cancer care in New South Wales (NSW) and Australian Capital Territory (ACT) in Australia, to identify factors that impact on utilisation of evidence‐based treatment and to report on the overall survival (OS) rate and the influencing factors on OS. Methods Cancer registry data linked to hospital records for all patients with breast cancer diagnosis in NSW and ACT between 2009 and 2014 were used to calculate rates of breast conserving surgery (BCS), mastectomy, sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND) and radiotherapy. Multivariate analysis used to identify factors that led to variations in care. 5‐year OS was calculated and cox regression model assessed factors that influenced survival. Results Data for 30,337 patients were analysed. BCS and mastectomy rates were 64% and 36%, respectively. The SLNB, ALND and ALND after SLNB rates were 61.5%, 32.1% and 6.4%, respectively. Radiotherapy was utilised in 63%. Younger age, socio‐economic disadvantage, longer distance to a radiotherapy facility and overseas place of birth were factors that predicted for increased rates of mastectomy and ALND. Radiotherapy was more likely to be utilised in later years of diagnosis, patients between 40‐69 years old, and those who lived in major cities and closer to a radiotherapy facility. 5‐year OS was 80.5%. Older patients, the socioeconomically disadvantaged and those advanced tumours had worse survival. Conclusion Variations in breast cancer care continue to exist in certain patient groups that we identified. Targeted strategic planning and further research to identify other drivers of existing disparities remain a priority.

Cancer treatment patterns and factors affecting receipt of treatment in older adults: results from the ASPREE Cancer Treatment Substudy (ACTS)

“…20,24 For breast cancer, our data resemble published data from both Australia and the US where most patients with non-metastatic breast cancer undergo surgery. 20,25,26 Rates of surgical treatment were greatest in this group, likely due to the use of relatively low-risk breastconserving procedures. Our cohort received slightly less radiation therapy than that reported in a younger Australian cohort (median age 61 versus 74.6 years) where 63% received radiation therapy.…”

“…Our cohort received slightly less radiation therapy than that reported in a younger Australian cohort (median age 61 versus 74.6 years) where 63% received radiation therapy. 25 Rates of radiation therapy were still the highest for the six commonest cancers, an expected finding given the widespread use of adjuvant radiation in localised or regional breast cancers. 20 In those with metastatic disease, rates of chemotherapy (31%) and hormonal therapy (63%) resemble the rates of large European and North American cohorts.…”

Breast surgery: a narrative review

“…In Australia, just under 70% of women undergo breast conservation 30 . Mastectomy is largely reserved for those with large volume or multifocal disease, if radiation is contraindicated, or for patient preference 30 . If mastectomy is undertaken, breast reconstruction can often be offered, which is either done by the breast surgeon or in combination with a plastic reconstructive surgeon.…”

“…Randomised trials confirmed that, for many women with breast cancer, breast‐conserving treatment (“lumpectomy”, usually with whole breast radiation) is at least as good if not superior to mastectomy in terms of survival, with excellent local control 29 . In Australia, just under 70% of women undergo breast conservation 30 . Mastectomy is largely reserved for those with large volume or multifocal disease, if radiation is contraindicated, or for patient preference 30 .…”

“…30 Mastectomy is largely reserved for those with large volume or multifocal disease, if radiation is contraindicated, or for patient preference. 30 If mastectomy is undertaken, breast reconstruction can often be offered, which is either done by the breast surgeon or in combination with a plastic reconstructive surgeon. Reconstruction after mastectomy, especially if done at the same procedure, improves psychological wellbeing.…”