Treatment variation in patients diagnosed with early stage breast cancer in Alberta from 2002 to 2010: a population-based study

Abstract

BackgroundBreast-conserving surgery (BCS) followed by radiotherapy is generally the preferred treatment for women diagnosed with early stage breast cancer. This study aimed to investigate the proportion of patients who receive BCS versus mastectomy and post-BCS radiotherapy, and explore factors associated with receipt of these treatments in Alberta, Canada.MethodsA retrospective population-based study was conducted that including all patients surgically treated with stage I-III breast cancer diagnosed in Alberta from 2002–2010. Clinical characteristics, treatment information and patient age at diagnosis were collected from the Alberta Cancer Registry. Log binomial multiple regression was used to calculate stage-specific relative risk estimates of receiving BCS and post-BCS radiotherapy.ResultsOf the 14 646 patients included in the study, 44% received BCS, and of those, 88% received post-BCS radiotherapy. The adjusted relative risk of BCS was highest in Calgary and lowest in Central Alberta for all disease stages. Relative to surgeries performed in Calgary, those performed in Central Alberta were significantly less likely to be BCS for stage I (RR = 0.65; 95% 0.57, 0.72), II (RR = 0.58; 95% 0.49, 0.68), and III (RR = 0.62; 95% CI: 0.37, 0.95) disease, respectively, adjusting for patient age at diagnosis, clinical and treatment characteristics. No significant variation of post-BCS radiotherapy was found.ConclusionsFactors such as region of surgical treatment should not be related to the receipt of standard care within a publicly-funded health care system. Further investigation is needed to understand the significant geographic variation present within the province in order to identify appropriate interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0680-z) contains supplementary material, which is available to authorized users.

Factors related to breast cancer detection mode and time to diagnosis in Alberta, Canada: a population-based retrospective cohort study

“…The significant variation in mode of detection and time to diagnosis across RHAs found in the current study suggests there are important differences in local coordination of breast cancer diagnosis. Similar regional variation in healthcare has been reported in several other jurisdictions, and for other diseases, indicating a need for routine monitoring within and/or across provinces (insurance providers) [ 45 – 48 ]. The public reporting efforts that have begun in the United Kingdom, Canada, and elsewhere [ 49 – 51 ] are good starting points for identifying variation but local insurers and/or healthcare providers must take it upon themselves to properly identify and address root causes to healthcare variation through programming and monitoring in order to properly address them.…”

Geographical Inequalities in Surgical Treatment for Localized Female Breast Cancer, Queensland, Australia 1997–2011: Improvements over Time but Inequalities Remain

“…We lack the information in our study cohort to explore these issues further. Studies from Australia [ 15 , 16 , 20 , 21 , 24 , 25 ], Europe [ 14 , 27 ], Canada [ 17 ], and the United States [ 18 , 19 , 26 ] have however consistently reported associations between sociodemographic, clinical, geographical and health-care factors and patterns of surgical care for early breast cancer suggesting that there are other factors, apart from accessibility and area disadvantage, that drive the choice of BCS versus mastectomy.…”

“…Despite these guidelines, widespread geographical and socioeconomic variations in the clinical management and patterns of care for early stage breast cancer persist, in particular, rural and more disadvantaged women are consistently less likely to receive BCS [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] than their urban or less disadvantaged counterparts. These disparities are widely attributed to a combination of clinical, demographic, environmental, and healthcare system factors including geographical access to and availability of specialised care, comorbidities, and patient preferences [ 14 , 15 , 16 , 18 , 19 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

Survival in stage I–III breast cancer patients by surgical treatment in a publicly funded health care system

“…In Quebec, 64% of breast cancer patients received BCS from 2007 to 2010 compared with 29% in Newfoundland. In Alberta, where 46% of patients received BCS, significant variation within the province has also been reported [9]. Here, we investigate breast cancer patient survival by surgery received within the publicly funded health care system present in Alberta, Canada.…”