Original articleVariations in the breast reconstruction rate in France: A nationwide study of 19,466 patients based on the French medico-administrative database
Introduction
Breast cancer is the most frequent cancer in women in Europe, with 464,000 new cases each year and 54,062 new cases in France in 2015 [1,2]. With improved treatment options resulting in a 10-year survival rate of 76%, it is essential to pay particular attention to the patient's quality of life [1]. Breast conserving surgery is performed as often as possible however, mastectomy is still needed in approximately 30% of the women treated for breast cancer [3]. For these patients, the benefit of breast reconstruction (BR) on quality of life has been widely reported due to improved physical, psychosocial and sexual well-being [[4], [5], [6]].
A review of the international literature showed significant variation in BR rates, which ranged from 4.9% to 81.2%, depending on the patient and tumour characteristics, surgeon/hospital and on psychological factors including patient choice. Among these considerations, age appears to be an important factor that influences BR rates [7]. In France, although the cost of BR is covered by national social insurance and is recommended by public health authorities, the proportion of women who opt for BR remains low (approximately 20% before 2012) [8].
The goal of this study was to investigate factors that influence BR in France in recent years by examining patient characteristics, especially patient age, as well as hospital features, regional medical access, and the interactions between these factors.
Section snippets
Patients
We used the French hospital stay database (Programme de Médicalisation des Systèmes d'Information, PMSI, secured access https://acces-securise.atih.sante.fr/vpn/index.html) to identify the population of women who underwent a mastectomy for breast cancer (BC) in 2012 and to identify whether or not these patients had BR. PMSI is a comprehensive medico-administrative database that routinely collects inpatient care data from all French hospitals. Information includes demographic data, place of
Description of the data
Of the 19,612 women who had a mastectomy due to BC in France in 2012, 19,466 were included in the current study, whereas 146 were excluded due to missing data for the FDep (0.7%). The median age in the study population was 62 years (interquartile range, 50–73; extremes, 17–101). Women aged 65 or over represented 42.7% of the study population (N = 8307). Overall, 5328 (27.4%) of the 19,466 women included in the study had BR: 13.7% (N = 2658) immediate BR and 13.7% (N = 2670) delayed BR.
Impact of age on the breast reconstruction rate
The BR
Discussion
We observed a significantly lower BR rate for older women operated in public hospitals than for younger women in a French nationwide cohort of nearly 20,000 women. Socioeconomic factors, regional heterogeneity and variation in the density of plastic surgeons also significantly influenced the BR rate.
The strength of our comprehensive study is the large number of patients from a nationwide cohort with complete data for analysis, which is representative of the current French breast cancer
Acknowledgements
The authors thank Malgorzata Cucchi for technical support and Nicolas Penel for helpful advice in publishing this manuscript.
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