Abstract
Aims
English national guidelines recommend that breast reconstruction is made available
to women with breast cancer undergoing mastectomy. We examined the use of immediate
reconstruction (IR) across English Cancer Networks, who are responsible for the regional
organisation of cancer services and ensuring equitable access to treatment.
Methods
We analysed Hospital Episodes Statistics data for all women with breast cancer who
underwent mastectomy in the English NHS between April 2006 and February 2009. IR rates
were calculated for the 30 Networks. Multivariable logistic regression was used to
adjust the rates for patient age, comorbidity, ethnicity and socioeconomic deprivation.
Results
Of 44 837 mastectomy patients, 7375 (16.5%) underwent IR. The IR rate was highest
in women under 50 years (32.7%) and lowest in women aged 70 years or over (1.5%),
and was lower in women with more comorbidities. Unadjusted IR rates varied from 8.4%
to 31.9% among the 30 Networks (p<0.001). Adjusting for their patient characteristics did not appreciably reduce Network-level
variation, with adjusted IR rates still ranging from 8.0% to 29.4% (p<0.001). The risk-model also suggested that non-white women and those from more deprived
areas were less likely to undergo immediate reconstruction.
Conclusions
There is substantial regional variation in immediate reconstruction use in England
that is not explained by the characteristics of the local patient population. English
Cancer Networks should act to reduce this variation. They should also examine why
rates of reconstruction differ between particular patient groups.
Keywords
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Article info
Publication history
Accepted:
June 7,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
