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Research

Rates of breast cancer surgery in Canada from 2007/08 to 2009/10: retrospective cohort study

Geoff Porter, Brandon Wagar, Heather Bryant, Maria Hewitt, Elaine Wai, Kelly Dabbs, Anne McFarlane and Rami Rahal
June 17, 2014 2 (2) E102-E108; DOI: https://doi.org/10.9778/cmajo.20130025
Geoff Porter
1Surgical Oncology, Dalhousie University, Halifax NS
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Brandon Wagar
2Canadian Institute for Health Information, Ottawa, Ont.
3School of Health Information Science, University of Victoria, Victoria, BC
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Heather Bryant
4Cancer Control, Canadian Partnership Against Cancer, Toronto, Ont.
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Maria Hewitt
5Canadian Institute for Health Information, Ottawa, Ont.
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Elaine Wai
6Faculty of Medicine, University of British Columbia, Vancouver BC,
7BC Cancer Agency (BCCA) — Vancouver Island Centre, Victoria, BC
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Kelly Dabbs
8Division of General Surgery, University of Alberta, Edmonton, Alta.
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Anne McFarlane
9Western Canada and Development Initiatives, Canadian Institute for Health Information, Ottawa, Ont.
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Rami Rahal
10System Performance and Surveillance, Canadian Partnership Against Cancer, Toronto, Ont.
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    Table 1: Mastectomy and breast-conserving surgery among women with unilateral invasive breast cancer, index versus final procedure* in Canada (n = 56 892), by province, 2007/08 to 2009/10
    ProcedureNo. of women†
    BCABSKMBONQCNBNSPEINLCanada
    Index procedure
    Breast-conserving surgery4 8772 490 7901 39614 73811 792 837 92813348138 517
    Mastectomy2 5962 482 896607 6 719 3 138 521 84310740618 375
    Total7 4734 9721 6862 00321 45714 9301 3581 77124088756 892
    Index mastectomy rate, % (95% CI)35
    (33.6–35.8)
    50
    (48.5– 51.3)
    53
    (50.7–55.5)
    30
    (28.2–32.3)
    31
    (30.6–31.9)
    21
    (20.3–21.6)
    38
    (35.7–40.9)
    48
    (45.2–49.9)
    45
    (38.2–50.8)
    46
    (42.4–49.0)
    32
    (31.9–32.6)
    Final procedure
    Breast-conserving surgery4 0402 204 5921 28213 41310 979 719 79410027734 439
    Mastectomy3 4332 7671 094 721 8 045 3 951 639 97714160922 453
    Total7 4734 9711 6862 00321 45814 9301 3581 77124188656 892
    Final mastectomy rate, % (95% CI)46
    (44.8–47.0)
    56
    (54.2–57.0)
    65
    (62.6–67.1)
    36
    (33.8–38.0)
    37
    (36.8–38.1)
    26
    (25.7–27.1)
    47
    (44.3–49.7)
    55
    (52.8–57.4)
    59
    (52.2–64.7)
    69
    (65.6–71.7)
    39
    (39.0–39.8)

    Note: CI = confidence interval.
*Small differences between the totals for the index and final procedures for selected provinces are because of women moving to another province during the treatment period.
†Unless otherwise stated.

      • View popup
      Table 2: Demographic factors associated with mastectomy rates in Canada* (n = 40 875), 2007/08 to 2009/10
      VariableNo. (%)† of womenMastectomy rate, %Adjusted‡
      odds ratio
      95% CI
      Travel time, min
      0–3924 161 (59)401.0 (ref)–
      40–897 884 (19)461.3(1.2–1.4)
      90–1795 131 (13)521.6(1.5–1.7)
      ≥ 1803 699 (9)571.9(1.8–2.0)
      Age, yr
      18–49 8 708 (21)481.0 (ref)–
      50–5910 165 (25)400.7(0.66–0.74)
      60–6910 346 (25)400.7(0.65–0.73)
      ≥ 7011 656 (29)481.0(0.92–1.03)
      Neighbourhood income quintile
      1 (least affluent) 6 273 (15)491.3(1.2–1.4)
      2 7 620 (19)471.2(1.1–1.3)
      3 8 216 (20)451.1(1.1–1.2)
      4 8 912 (22)431.1(1.0–1.20)
      5 (most affluent) 9 854 (24)391.0 (ref) –

      Note: CI = confidence interval.
*Quebec, Yukon, Northwest Territories and Nunavut were not included in this analysis. 
†Women for whom age, neighbourhood income quintile or travel time could not be calculated (n = 972) were excluded.
‡Adjusted for age, neighbourhood income quintile and travel time.

        • View popup
        Table 3: Crude and adjusted final mastectomy rates among women in Canada* with unilateral invasive breast cancer 
(n = 40 875), 2007/08 to 2009/10, by province
        ProcedureNo. of women†‡
        BCABSKMBONNBNSPEINLCanada
        Breast-conserving surgery3 8572 161 5741 24713 180 712 768 9826222 859
        Mastectomy3 2792 7241 076 712 7 920 626 96514057418 016
        Total7 1364 8851 6501 95921 1001 3381 73323883640 875
        Crude§ mastectomy rate, % 46 56 65 36 38 47 56 59 69 44
        Adjusted¶ mastectomy rate, % 45 56 60 35 39 41 52 56 61NA

        Note: NA = not applicable.
*Quebec, Yukon, Northwest Territories and Nunavut were not included in this analysis.
†Unless otherwise stated.
‡Women for whom age, neighbourhood income quintile or travel time could not be calculated (n = 972) were excluded.
§Crude rates in this table differ from those presented in Table 2 because of exclusions from the logistic regression.
¶Adjusted for age, neighbourhood income quintile and travel time.

          • View popup
          Table 4: Rates of re-excision among women who underwent breast-conserving surgery for invasive breast cancer 
as the index procedure (n = 38 517), by province, 2007/08 to 2009/10
          ProcedureNo. of women*
          BCABSKMBONQCNBNSPEINLCanada
          Index breast-conserving surgery4 8772 4907901 39614 73811 79283792813348138 517
          Re-excision
          Breast-conserving surgery 995 229176 46 1 756 1 237137109 19 67 4 776
          Mastectomy 837 286114 198 1 325 813118134 33204 4 078
          Total1 832 515290 244 3 081 2 050255243 52271 8 854
          Re-excision rate, % 38 21 37 17 21 17 30 26 39 56 23

          *Unless otherwise stated.

            • View popup
            Table 5: Location of index surgical procedure among women with unilateral breast cancer (n = 56 992), by province, 2007/08 to 2009/10
            ProcedureNo. of women*
            BCAlta.Sask.Man.Ont.Que.NBNSPEINLCanada
            Index breast-conserving surgery
            Day surgery3 1081 1044621 02611 973 7 715544626 5541427 053
            Inpatient1 7691 386328 370 2 765 4 077293302 78 6711 464
            Total4 8772 4907901 39614 73811 79283792813348138 517
            Index mastectomy
            Day surgery 169 35 < 5† 134 2 203 784135114 < 5† 32 3 609
            Inpatient2 4272 447893 473 4 516 2 35438672910737414 766
            Total2 5962 482896 607 6 719 3 13852184310740618 375

            *Unless otherwise stated.
†Data suppressed because of small cell size.

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            Rates of breast cancer surgery in Canada from 2007/08 to 2009/10: retrospective cohort study
            Geoff Porter, Brandon Wagar, Heather Bryant, Maria Hewitt, Elaine Wai, Kelly Dabbs, Anne McFarlane, Rami Rahal
            Apr 2014, 2 (2) E102-E108; DOI: 10.9778/cmajo.20130025

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            Rates of breast cancer surgery in Canada from 2007/08 to 2009/10: retrospective cohort study
            Geoff Porter, Brandon Wagar, Heather Bryant, Maria Hewitt, Elaine Wai, Kelly Dabbs, Anne McFarlane, Rami Rahal
            Apr 2014, 2 (2) E102-E108; DOI: 10.9778/cmajo.20130025
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