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Large variation between hospitals in immediate breast reconstruction rates after mastectomy for breast cancer in the Netherlands.
J Plast Reconstr Aesthet Surg 2017; 70(2):215-221JP

Abstract

BACKGROUND

The present study aimed to describe the use of immediate breast reconstruction (IBR) after mastectomy for invasive breast cancer and ductal carcinoma in situ (DCIS) in hospitals in the Netherlands and determine whether patient and tumor factors account for the variation.

METHODS

Patients undergoing mastectomy for primary invasive breast cancer or DCIS diagnosed between January 1, 2011 and December 31, 2013 were selected from the NABON Breast Cancer Audit. All the 92 hospitals in the Netherlands were included. The use of IBR in all hospitals was compared using unadjusted and adjusted analyses. Patient and tumor factors were evaluated by univariate and multivariate analyses.

RESULTS

In total, 16,953 patients underwent mastectomy: 15,072 for invasive breast cancer and 1881 for DCIS. Unadjusted analyses revealed considerable variation between hospitals in postmastectomy IBR rates for invasive breast cancer (mean 17%; range 0-64%) and DCIS (mean 42%; range 0-83%). For DCIS, younger age and multifocal disease were factors that significantly increased IBR rates. For patients diagnosed with invasive breast cancer, IBR was more often used in younger patients, multifocal tumors, smaller tumors, tumors with a lower grade, absence of lymph node involvement, ductal carcinomas, or hormone-receptor positive/HER2-positive tumors. After case-mix adjustments for these factors, the variation in the use of IBR between hospitals remained large (0-43% for invasive breast cancer and 0-74% for DCIS).

CONCLUSIONS

A large variation between hospitals was found in postmastectomy IBR rates in the Netherlands for both invasive breast cancer and DCIS even after adjustment for patient and tumor factors.

Authors+Show Affiliations

Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.Dutch Breast Cancer Association, Utrecht, The Netherlands.Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands; Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. Electronic address: s.siesling@iknl.nl.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27993547

Citation

van Bommel, A C M., et al. "Large Variation Between Hospitals in Immediate Breast Reconstruction Rates After Mastectomy for Breast Cancer in the Netherlands." Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, vol. 70, no. 2, 2017, pp. 215-221.
van Bommel AC, Mureau MA, Schreuder K, et al. Large variation between hospitals in immediate breast reconstruction rates after mastectomy for breast cancer in the Netherlands. J Plast Reconstr Aesthet Surg. 2017;70(2):215-221.
van Bommel, A. C., Mureau, M. A., Schreuder, K., van Dalen, T., Vrancken Peeters, M. T., Schrieks, M., ... Siesling, S. (2017). Large variation between hospitals in immediate breast reconstruction rates after mastectomy for breast cancer in the Netherlands. Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, 70(2), pp. 215-221. doi:10.1016/j.bjps.2016.10.022.
van Bommel AC, et al. Large Variation Between Hospitals in Immediate Breast Reconstruction Rates After Mastectomy for Breast Cancer in the Netherlands. J Plast Reconstr Aesthet Surg. 2017;70(2):215-221. PubMed PMID: 27993547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Large variation between hospitals in immediate breast reconstruction rates after mastectomy for breast cancer in the Netherlands. AU - van Bommel,A C M, AU - Mureau,M A M, AU - Schreuder,K, AU - van Dalen,T, AU - Vrancken Peeters,M T F D, AU - Schrieks,M, AU - Maduro,J H, AU - Siesling,S, Y1 - 2016/11/11/ PY - 2016/03/30/received PY - 2016/10/11/revised PY - 2016/10/30/accepted PY - 2016/12/21/pubmed PY - 2017/4/14/medline PY - 2016/12/21/entrez KW - Breast cancer KW - Case-mix KW - Hospital variation KW - Immediate breast reconstruction KW - Mastectomy SP - 215 EP - 221 JF - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JO - J Plast Reconstr Aesthet Surg VL - 70 IS - 2 N2 - BACKGROUND: The present study aimed to describe the use of immediate breast reconstruction (IBR) after mastectomy for invasive breast cancer and ductal carcinoma in situ (DCIS) in hospitals in the Netherlands and determine whether patient and tumor factors account for the variation. METHODS: Patients undergoing mastectomy for primary invasive breast cancer or DCIS diagnosed between January 1, 2011 and December 31, 2013 were selected from the NABON Breast Cancer Audit. All the 92 hospitals in the Netherlands were included. The use of IBR in all hospitals was compared using unadjusted and adjusted analyses. Patient and tumor factors were evaluated by univariate and multivariate analyses. RESULTS: In total, 16,953 patients underwent mastectomy: 15,072 for invasive breast cancer and 1881 for DCIS. Unadjusted analyses revealed considerable variation between hospitals in postmastectomy IBR rates for invasive breast cancer (mean 17%; range 0-64%) and DCIS (mean 42%; range 0-83%). For DCIS, younger age and multifocal disease were factors that significantly increased IBR rates. For patients diagnosed with invasive breast cancer, IBR was more often used in younger patients, multifocal tumors, smaller tumors, tumors with a lower grade, absence of lymph node involvement, ductal carcinomas, or hormone-receptor positive/HER2-positive tumors. After case-mix adjustments for these factors, the variation in the use of IBR between hospitals remained large (0-43% for invasive breast cancer and 0-74% for DCIS). CONCLUSIONS: A large variation between hospitals was found in postmastectomy IBR rates in the Netherlands for both invasive breast cancer and DCIS even after adjustment for patient and tumor factors. SN - 1878-0539 UR - https://www.unboundmedicine.com/medline/citation/27993547/Large_variation_between_hospitals_in_immediate_breast_reconstruction_rates_after_mastectomy_for_breast_cancer_in_the_Netherlands_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1748-6815(16)30483-1 DB - PRIME DP - Unbound Medicine ER -