Several international publications report recent changes in the management of breast cancer (BC), in particular, an increase in the rate of mastectomy for early-stage disease.1 2 3 4 5 6
To identify any variation in BC management in Victoria utilising a linkage between the Victorian Admitted Episode Dataset (VAED) and the Victorian Cancer Registry (VCR).
A retrospective cohort study was performed on 29,422 female patients with a diagnosis of primary invasive BC (4 January 2000 - 31December 2010).
The number of women who underwent a definitive local procedure (DLP) was 26,296. The DLP was mastectomy in 8,203 women (7,542 unilateral and 661 bilateral) and wide local excision (WLE) in 16,761 women. Unilateral mastectomy was strongly correlated with rural/remote regions, increasing age, higher grade (II/III) and lobular histology. Bilateral mastectomy increased from 14 cases in 2000 to 139 cases in 2010. The median length of stay was 4.1 days for mastectomy and 3.2 days for WLE. Axillary clearance appeared to decline over the study timeframe (54.8% in 2010). As a proportion of all patients who underwent a DLP in 2010, 64.6% had a sentinel node biopsy.
With regard to reconstructive surgery (RS), 2,078 women had 3,574 admissions in the study timeframe. A higher proportion of patients who underwent RS were privately insured (33.0% public and 67.0% private). RS was negatively correlated with remote locations.
Adjuvant chemotherapy (ACT) was administered to 21.9% of patients. The rate of ACT increased substantially across the study timeframe (from 14.6% in 2000 to 32.0% in 2010), probably secondary to improved coding procedures. ACT was strongly associated with younger age, higher grade, lobular histology and private insurance.
While the rate of unilateral mastectomy remained fairly constant, we report an increase in the rate of bilateral mastectomy, RS, and ACT across the study timeframe.