title: Breast Cancer Incidence and Predictors of Surgical Outcome: a Nationwide Longitudinal Study in Taiwan.
abstract: OBJECTIVE
  Despite the huge and growing global burden of patients who require breast cancer surgery, high-quality population-based studies of breast cancer trends and outcomes are scarce. The purpose of this study was to explore the incidence of breast cancer and predictors of hospital resource utilisation, mortality and recurrence in a nationwide population of patients who have received surgery.
  
  
  METHODS
  This retrospective study analysed trends and outcomes in a Taiwan population of 77 971 patients after breast cancer surgery during 1996-2010. The Cox proportional hazards model was used for multivariate assessment of both mortality and recurrence predictors.
  
  
  RESULTS
  The data analysis indicated that, during this period, the estimated mean hospital treatment cost and mean length of stay increased by 16.3% and 53.4%, respectively. The estimated mean overall survival time was 138.9 months (standard deviation 0.3 months) and the overall 1, 3, 5 and 10 year survival rates were 97.3, 89.2, 82.2 and 70.1%, respectively. The estimated mean overall recurrence time was 10.8 months (standard deviation 0.2 months) and the overall 1, 3, 5 and 10 year recurrence rates were 0.1, 18.8, 26.6 and 36.0%, respectively. Outcomes were significantly associated with age, Deyo-Charlson comorbidity index score, surgeon seniority, hospital volume, surgeon volume, surgery type, hospital level and baseline comorbidities (P<0.001).
  
  
  CONCLUSIONS
  Analyses of these population-based data revealed simultaneous increases in the standard incidence of breast cancer surgery and its associated medical resource utilisation. Notably, healthcare providers and patients should recognise that both patient attributes and hospital attributes may affect breast cancer surgery outcomes.
authors.affiliation: Division of General & Gastroenterological Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; Department of Business Management, National Sun Yat-sen University, Kaohsiung 80607, Taiwan, Republic of China.
authors.forename: Hong-Tai
authors.initials: HT
authors.lastname: Chang
authors.affiliation: Department of Business Management, National Sun Yat-sen University, Kaohsiung 80607, Taiwan, Republic of China; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan, Republic of China.
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
authors.affiliation: Division of General & Gastroenterological Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
authors.forename: Being-Whey
authors.initials: BW
authors.lastname: Wang
authors.affiliation: Department of Business Management, National Sun Yat-sen University, Kaohsiung 80607, Taiwan, Republic of China. Electronic address: hshi@kmu.edu.tw.
authors.forename: Shu-Chuan Jennifer
authors.initials: SJ
authors.lastname: Yeh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D015897:Comorbidity; D005260:Female; D017722:Hospital Charges; D017721:Hospital Costs / Q000639:trends*; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends*; D008137:Longitudinal Studies; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Breast cancer; hospital resource utilisation; mortality rate; recurrence rate surgery; trends