title: Geographical disparity in breast reconstruction following mastectomy has reduced over time.
abstract: BACKGROUND
  Breast reconstruction (BR) following mastectomy for breast cancer has been shown to improve quality of life and body image; however, there is significant geographic variation in BR rates. We explored factors associated with BR following mastectomy.
  
  
  METHODS
  This is a population-based data linkage study consisting of cancer registry records linked to hospital inpatient episodes for 4104 women aged 20 years and over-diagnosed with a first primary invasive localized stage breast cancer between 1997 and 2012 in Queensland, Australia, who underwent a mastectomy. Multivariate logistic regression was used to model predictors of BR.
  
  
  RESULTS
  Overall, 481 women (11.7%) underwent reconstruction. Proportions increased over time and were higher for younger women. Younger age, more recent diagnosis, living in high or very high accessibility areas or less disadvantaged areas, smaller tumours and attending a private or high-volume hospital independently increased the odds of reconstruction. The geographical disparity reduced significantly over time.
  
  
  CONCLUSIONS
  Geographical barriers to accessing BR have reduced; however, continued monitoring and further research to inform strategies to further reduce subgroup disparities remain a priority.
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia.
authors.forename: Paramita
authors.initials: P
authors.lastname: Dasgupta
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia.|School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.|Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
authors.forename: Philippa H
authors.initials: PH
authors.lastname: Youl
authors.affiliation: Mater Medical Centre, Brisbane, Queensland, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Pyke
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia.|School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.|School of Population Health, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Aitken
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia.|School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.|Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Baade
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000523:psychology; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011788:Quality of Life; D011793:Queensland / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000523:psychology
keywords: breast cancer; healthcare disparities; mastectomy; reconstructive surgical procedure; trends