Impact of geographic location on surgical outcomes of women with breast cancer.
BACKGROUND
The aim of this study is to use the Breast Surgeons of Australia and New Zealand Quality Audit to evaluate the diagnostic work up and surgical treatment path for Australian women with early breast cancer in relation to geographic location.


METHODS
We accessed data on patient geographic demographics, diagnostic and surgical procedures and cancer characteristics in 115,872 episodes of early breast cancer reported to the Quality Audit between 1998 and 2012. Tumour size, grade and number, lymph node positivity and lymphovascular invasion are the major prognostic factors adjusted for.


RESULTS
Core biopsy is the most frequently performed diagnostic method and open biopsy the least (P=0.001). Remote locations have the highest proportion of open biopsies and cities the lowest (13.8 versus 9.8%, P=0.001). The outer regional/remote patient group has a higher likelihood of an open biopsy than city patients (odds ratio 1.5; 95% confidence interval 1.1-2.2 P=0.02). Reconstruction rates are low throughout ranging from 3 to 4% (P=0.001). Cities have the highest proportion of no surgery (1.5%, P=0.001). Cities have the highest proportion of breast conserving surgery and the remote the lowest (64.5% versus 29.9%, P=0.001). Outer regional locations have the highest proportion of mastectomies and cities the lowest (38 versus 29.9%, P=0.001). The likelihood of receiving radiotherapy is associated with geographic location of residence and geographic distribution of the radiotherapy facility (P=0.002, P=0.001).


CONCLUSIONS
Geographic location of residence is associated with the diagnostic work up and surgical treatment of Australian women with early breast cancer.
Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
Jonathan
J
Azzopardi
David
D
Walsh
Chilton
C
Chong
Corey
C
Taylor
D001315:Australia / Q000453:epidemiology; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000706:statistics & numerical data; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009520:New Zealand / Q000453:epidemiology; D011379:Prognosis; D012111:Residence Characteristics; D012307:Risk Factors; D016896:Treatment Outcome
breast cancer; diagnostic method; geographic location; outcome; surgical treatment