Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Ann Surg Oncol. 2018 Oct;25(10):2994-3003. doi: 10.1245/s10434-018-6619-y. Epub 2018 Jul 3.
Two new cancer centers providing radiation therapy opened in Alberta, Canada, in 2010 and 2013, respectively. We aimed to assess whether opening the new RT centers influenced mastectomy rates for breast cancer.
Breast cancer patients who underwent surgery from 2004 through 2015 were identified from the Alberta Cancer Registry. Mastectomy rates for 64 predefined health status areas (HSAs) were calculated after adjusting for patient and system factors. Variations in mastectomy rates among the HSAs were quantified using weighted coefficient of variation (CV). Multivariable logistic regressions were performed to determine associations between driving time and mastectomy use in the entire cohort and in subgroups.
Of the 21,872 patients, the proportion of patients who lived a ≤ 60 min drive from the nearest RT center significantly increased from 68.8% (95% CI 67.7-69.9%) to 80.7% (95% CI 79.5-81.9%) during the study period. Concurrently, the crude provincial mastectomy rate decreased from 56.2% (95% CI 55.3-57.1%) to 45.3% (95% CI 44.1-46.5%). However, variation in adjusted mastectomy rates (weighted CV) across the 64 HSAs increased from 9.5 to 14.6. Factors associated with mastectomy included age, larger tumor size, lymph node involvement, higher tumor grade, molecular subtype, lobular histology type, more comorbidities, academic institution, region, earlier period of diagnosis, and longer driving time to the nearest RT center.
Opening new RT centers in previously underserved regions reduced driving times to the nearest center, and was associated with a reduction in mastectomy rates; however, these reductions among regions across the province were not uniform.
2010 年和 2013 年，加拿大艾伯塔省分别开设了两家新的癌症中心，提供放射治疗。我们旨在评估开设新的放射治疗中心是否会影响乳腺癌的乳房切除术率。
从艾伯塔省癌症登记处确定了 2004 年至 2015 年期间接受手术的乳腺癌患者。在调整患者和系统因素后，计算了 64 个预先定义的健康状况区域（HSAs）的乳房切除术率。使用加权变异系数（CV）量化 HSA 之间乳房切除术率的变化。在整个队列和亚组中，进行多变量逻辑回归以确定驾驶时间与乳房切除术使用之间的关联。
在 21872 名患者中，居住在距离最近放射治疗中心车程≤60 分钟的患者比例从研究期间的 68.8%（95%置信区间 67.7-69.9%）显著增加到 80.7%（95%置信区间 79.5-81.9%）。同时，全省乳房切除术的粗率从 56.2%（95%置信区间 55.3-57.1%）下降至 45.3%（95%置信区间 44.1-46.5%）。然而，64 个 HSA 中调整后的乳房切除术率（加权 CV）的变化从 9.5 增加到 14.6。与乳房切除术相关的因素包括年龄、更大的肿瘤大小、淋巴结受累、更高的肿瘤分级、分子亚型、小叶组织学类型、更多的合并症、学术机构、地区、更早的诊断期和到最近放射治疗中心的更长驾驶时间。
在以前服务不足的地区开设新的放射治疗中心减少了到最近中心的驾驶时间，并与乳房切除术率的降低相关；然而，全省各地区之间的这些减少并不均匀。
