title: Barriers to breast reconstruction after mastectomy in Nova Scotia.
abstract: BACKGROUND
  Breast reconstruction after mastectomy is associated with social, psychological and physical benefits. Barriers to breast reconstruction in the United States include age, stage of disease, socioeconomic status and geographic location; however, little is known about the effects of these factors in the Canadian context of a universal health care system. We sought to determine the rate of breast reconstruction in Nova Scotia, identify characteristics influencing access to the procedure and describe the rates of different reconstructive options.
  
  
  METHODS
  We conducted a retrospective cohort study involving all women in Nova Scotia who received diagnoses of breast cancer and had mastectomies between 1991 and 2001. We linked data from 2 administrative databases and performed analyses for each year in the study period. We followed the women until the end of the study period (2001). We used logistic regression to evaluate potential barriers to reconstruction.
  
  
  RESULTS
  A total of 3717 women had mastectomies during the 10-year study period; of these women, 142 (3.8%) had breast reconstruction. The reconstruction rate increased to more than 5% in 3 of the last 4 years. Factors affecting the rate of breast reconstruction included patient age, stage of disease and year of mastectomy. Household income did not significantly affect the likelihood of women seeking breast reconstruction.
  
  
  CONCLUSIONS
  The rate of breast reconstruction in Nova Scotia (3.8%) is considerably lower than rates reported in the United States (8%-45%). The fact that household income did not influence the breast reconstruction rate may reflect the universal nature of Canada's public health care system.
authors.affiliation: Division of Plastic Surgery, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Novia Scotia.
authors.forename: G Philip
authors.initials: GP
authors.lastname: Barnsley
authors.forename: Leif
authors.initials: L
authors.lastname: Sigurdson
authors.forename: Susan
authors.initials: S
authors.lastname: Kirkland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016462:Mammaplasty / Q000706:statistics & numerical data*; D008408:Mastectomy; D008875:Middle Aged; D009674:Nova Scotia / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult