title: Trends in the surgical procedures of women with incident breast cancer in Catalonia, Spain, over a 7-year period (2005-2011).
abstract: BACKGROUND
  Breast cancer (BC) is the most frequent cancer in women, accounting for 28% of all tumors among women in Catalonia (Spain). Mastectomy has been replaced over time by breast-conserving surgery (BCS) although not as rapidly as might be expected. The aim of this study was to assess the evolution of surgical procedures in incident BC cases in Catalonia between 2005 and 2011, and to analyze variations based on patient and hospital characteristics.
  
  
  METHODS
  We processed data from the Catalonian Health Service's Acute Hospital Discharge database (HDD) using ASEDAT software (Analysis, Selection and Extraction of Tumor Data) to identify all invasive BC incident cases according to the codes 174.0-174.9 of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) that were attended for the one-year periods in 2005, 2008 and 2011. Patients were classified according to surgical procedures (BCS vs mastectomy, and immediate vs delayed reconstruction), and results were compared among periods according to age, stage, comorbidity and hospital level.
  
  
  RESULTS
  BC surgical procedures were performed in more than 80% of patients. Surgical cases showed a significant increasing trend in the proportion of women aged 50-69 years, more advanced disease stages, higher comorbidity and they were attended in hospitals of less complexity level throughout the study period. Similar pattern was found for patients treated with BCS, which increased significantly from 67.9% in 2005 to 74.0% in 2011.Simple lymph node removal increased significantly (from 48.8% to 71.4% and from 63.6% to 67.8% for 2005 and 2011 in conservative and radical surgery, respectively). A slightly increase in the proportion of mastectomized young women (from 28% in 2005 to 34% in 2011) was detected, due to multiple factors. About 22% of women underwent post-mastectomy breast reconstruction, this being mostly immediate.
  
  
  CONCLUSIONS
  The use of HDD linked to the ASEDAT allowed us to evaluate BC surgical treatment in Catalonia. A consolidating increasing trend of BCS was observed in women aged 50-69 years, which corresponds with the pattern in most European countries. Among the mastectomized patients, immediate breast reconstructions have risen significantly over the period 2005-2011.
authors.affiliation: Catalonian Cancer Registry, Cancer Planning Directorate, Av, Gran Vía 199-203, 08908 L'Hospitalet de Llobregat, Spain. jmescriba@iconcologia.net.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Escribà
authors.forename: Laura
authors.initials: L
authors.lastname: Pareja
authors.forename: Laura
authors.initials: L
authors.lastname: Esteban
authors.forename: Jordi
authors.initials: J
authors.lastname: Gálvez
authors.forename: Angels
authors.initials: A
authors.lastname: Melià
authors.forename: Laura
authors.initials: L
authors.lastname: Roca
authors.forename: Ramon
authors.initials: R
authors.lastname: Clèries
authors.forename: Xavier
authors.initials: X
authors.lastname: Sanz
authors.forename: Montse
authors.initials: M
authors.lastname: Bustins
authors.forename: María J
authors.initials: MJ
authors.lastname: Pla
authors.forename: Miguel J
authors.initials: MJ
authors.lastname: Gil
authors.forename: Josep M
authors.initials: JM
authors.lastname: Borrás
authors.forename: Josepa
authors.initials: J
authors.lastname: Ribes
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008408:Mastectomy / Q000379:methods / Q000639:trends*; D013030:Spain