title: Survival from breast cancer: an analysis of Australian data by surgeon case load, treatment centre location, and health insurance status.
abstract: OBJECTIVE
  Early invasive breast cancer data from the Australian National Breast Cancer Audit were used to compare case fatality by surgeon case load, treatment centre location and health insurance status.
  
  
  METHODS
  Deaths were traced to 31 December 2007, for cancers diagnosed in 1998-2005. Risk of breast cancer death was compared using Cox proportional hazards regression.
  
  
  RESULTS
  When adjustment was made for age and clinical risk factors: (i) the relative risk of breast cancer death (95% confidence limit) was lower when surgeons' annual case loads exceeded 20 cases, at 0.87 (0.76, 0.995) for 21-100 cases and 0.83 (0.72, 0.97) for higher case loads. These relative risks were not statistically significant when also adjusting for treatment centre location (P ≥ 0.15); and (ii) compared with major city centres, inner regional centres had a relative risk of 1.32 (1.18, 1.48), but the risk was not elevated for more remote sites at 0.95 (0.74, 1.22). Risk of death was not related to private insurance status.
  
  
  CONCLUSIONS
  Higher breast cancer mortality in patients treated in inner regional than major city centres and in those treated by surgeons with lower case loads requires further study.
authors.affiliation: Population Health, Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012, Australia. roder@internode.on.net
authors.forename: David
authors.initials: D
authors.lastname: Roder
authors.forename: Primali
authors.initials: P
authors.lastname: de Silva
authors.forename: Helen M
authors.initials: HM
authors.lastname: Zorbas
authors.forename: James
authors.initials: J
authors.lastname: Kollias
authors.forename: Peter L
authors.initials: PL
authors.lastname: Malycha
authors.forename: Chris M
authors.initials: CM
authors.lastname: Pyke
authors.forename: Ian D
authors.initials: ID
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001943:Breast Neoplasms; D002648:Child; D005260:Female; D013502:General Surgery; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008875:Middle Aged; D011365:Professional Practice Location; D016016:Proportional Hazards Models; D017741:Survivors; D055815:Young Adult