title: Treatment variation in patients diagnosed with early stage breast cancer in Alberta from 2002 to 2010: a population-based study.
abstract: BACKGROUND
  Breast-conserving surgery (BCS) followed by radiotherapy is generally the preferred treatment for women diagnosed with early stage breast cancer. This study aimed to investigate the proportion of patients who receive BCS versus mastectomy and post-BCS radiotherapy, and explore factors associated with receipt of these treatments in Alberta, Canada.
  
  
  METHODS
  A retrospective population-based study was conducted that including all patients surgically treated with stage I-III breast cancer diagnosed in Alberta from 2002-2010. Clinical characteristics, treatment information and patient age at diagnosis were collected from the Alberta Cancer Registry. Log binomial multiple regression was used to calculate stage-specific relative risk estimates of receiving BCS and post-BCS radiotherapy.
  
  
  RESULTS
  Of the 14 646 patients included in the study, 44% received BCS, and of those, 88% received post-BCS radiotherapy. The adjusted relative risk of BCS was highest in Calgary and lowest in Central Alberta for all disease stages. Relative to surgeries performed in Calgary, those performed in Central Alberta were significantly less likely to be BCS for stage I (RR = 0.65; 95% 0.57, 0.72), II (RR = 0.58; 95% 0.49, 0.68), and III (RR = 0.62; 95% CI: 0.37, 0.95) disease, respectively, adjusting for patient age at diagnosis, clinical and treatment characteristics. No significant variation of post-BCS radiotherapy was found.
  
  
  CONCLUSIONS
  Factors such as region of surgical treatment should not be related to the receipt of standard care within a publicly-funded health care system. Further investigation is needed to understand the significant geographic variation present within the province in order to identify appropriate interventions.
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada. slf1@ualberta.ca.
authors.forename: Stacey
authors.initials: S
authors.lastname: Fisher
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada. hgao1@ualberta.ca.
authors.forename: He
authors.initials: H
authors.lastname: Gao
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada. yyasui@ualberta.ca.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.affiliation: Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. dabbs@shaw.ca.
authors.forename: Kelly
authors.initials: K
authors.lastname: Dabbs
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada. mwinget@stanford.edu.|Department of Medicine, Stanford University, Palo Alto, CA, USA. mwinget@stanford.edu.
authors.forename: Marcy
authors.initials: M
authors.lastname: Winget
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D002170:Canada; D003131:Combined Modality Therapy / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer; D005260:Female; D005843:Geography; D006801:Humans; D015409:Mastectomy, Radical / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome