title: A comparison of surgical and radiotherapy breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of "optimal" therapy.
abstract: BACKGROUND
  Different jurisdictions report different breast cancer treatment rates. Evidence-based utilization models may be specific to derived populations. We compared predicted optimal with actual radiotherapy utilization in British Columbia, Canada; Dundee, Scotland; and Perth, Western Australia.
  
  
  METHODS
  Data were analyzed for differences in demography, tumor, and treatment. Epidemiological data were fitted to published Australian optimal radiotherapy utilization trees and region-specific optimal treatment rates were calculated. Optimal and actual surgery/radiotherapy rates from 2 population-based and 1 institution-based registries were compared for patients diagnosed with breast cancer between 2000 and 2004, and 2002 for British Columbia.
  
  
  RESULTS
  Mastectomy rates differed between British Columbia (40%), Western Australia (44%), and Dundee (47%, p<0.01). Radiotherapy rates differed between British Columbia (60%), Western Australia (52%), and Dundee (49%, p<0.01). Actual radiotherapy utilization rates were lower than optimal estimates. Region-specific optimal utilization rates at diagnosis varied from 57% to 71% for radiotherapy and 62% to 64% when taking into account patient preference. Variation was attributed to local differences in demography and tumor stage.
  
  
  CONCLUSIONS
  Actual treatment rates varied, and were associated with patterns of care and guideline differences. Actual radiotherapy rates were lower than optimal rates. Differences between optimal and actual utilization may be due to access shortfalls, and patient preference.
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Liverpool, NSW 1871, Australia. andrewfong@eml.cc
authors.forename: A
authors.initials: A
authors.lastname: Fong
authors.forename: J
authors.initials: J
authors.lastname: Shafiq
authors.forename: C
authors.initials: C
authors.lastname: Saunders
authors.forename: A M
authors.initials: AM
authors.lastname: Thompson
authors.forename: S
authors.initials: S
authors.lastname: Tyldesley
authors.forename: I A
authors.initials: IA
authors.lastname: Olivotto
authors.forename: M B
authors.initials: MB
authors.lastname: Barton
authors.forename: J A
authors.initials: JA
authors.lastname: Dewar
authors.forename: S
authors.initials: S
authors.lastname: Jacob
authors.forename: W
authors.initials: W
authors.lastname: Ng
authors.forename: C
authors.initials: C
authors.lastname: Speers
authors.forename: G P
authors.initials: GP
authors.lastname: Delaney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D001955:British Columbia; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018714:Radiotherapy, Adjuvant / Q000592:standards / Q000706:statistics & numerical data*; D012042:Registries; D012606:Scotland; D014904:Western Australia