Abstract
Aims
Minimum volume thresholds were introduced in France in 2008 to improve the quality
of cancer care. We investigated whether/how the quality of treatment decisions in
breast cancer surgery had evolved before and after this policy was implemented.
Methods
We used Hospital Episode Statistics for all women having undergone breast conserving
surgery (BCS) or mastectomy in France in 2005 and 2012. Three surgical procedures
considered as better treatment options were analyzed: BCS, immediate breast reconstruction
(IBR) and sentinel lymph node biopsy (SLNB). We studied the mean rates and variation
according to the hospital profile and volume.
Results
Between 2005 and 2012, the volume of breast cancer surgery increased by 11% whereas
one third of the hospitals no longer performed this type of surgery. In 2012, the
mean rate of BCS was 74% and similar in all hospitals whatever the volume. Conversely,
IBR and SLNB rates were much higher in cancer centers (CC) and regional teaching hospitals
(RTH) [IBR: 19% and 14% versus 8% on average; SLNB: 61% and 47% versus 39% on average];
the greater the hospital volume, the higher the IBR and SLNB rates (p < 0.0001). Overall,
whatever the surgical procedure considered, inter-hospital variation in rates declined
substantially in CC and RTH.
Conclusions
We identified considerable variation in IBR and SLNB rates between French hospitals.
Although more complex and less standardized than BCS, most clinical guidelines recommended
these procedures. This apparent heterogeneity suggests unequal access to high-quality
procedures for women with breast cancer.
Keywords
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Article info
Publication history
Published online: October 05, 2015
Accepted:
September 21,
2015
Identification
Copyright
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
