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Regional Variation in Breast Cancer Surgery: Results from the National Cancer Database (NCDB)
*Alexander Chiu, *Princess Thomas, *Brigid K Killelea, *Nina Horowitz, Anees B Chagpar, Donald R Lannin
Yale University, New Haven, CT

OBJECTIVES: A 1992 paper in the NEJM described regional variation in the utilization of breast conservation surgery (BCS) with the highest rate in New England and the lowest rates in the Southern US. The purpose of this study is to see whether this difference persists and to examine regional variation in breast reconstruction. DESIGN: Retrospective review of national database. SETTING: The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society and contains about 70% of the cancer cases in the United States. PATIENTS: All 761,498 women in the NCDB diagnosed with breast cancer from 2010 through 2013 who underwent definitive breast surgery, broken down by 9 geographic regions. OUTCOME MEASURE: Rate of breast preservation and reconstruction RESULTS: There are large differences in the rate of BCS with the highest in New England (69%) followed by Middle Atlantic (64%) and the lowest in East South Central (49%) followed by West South Central (50%), p<0.001. Similarly for mastectomy patients, the rate of reconstruction varied with the highest in Middle Atlantic (44%) followed by New England (41%) and the lowest in East South Central (26%) followed by West South Central (27%), p<0.001. These differences persisted in multivariable models adjusted for race, ethnicity, tumor size, nodal status, grade, histology, and molecular subtype. Compared to East South Central, the odds ratio for BCS in New England was 2.5 (95% CI 2.4-2.6), and the OR for reconstruction in Middle Atlantic was 2.4 (95% CI 2.3-2.5) and in New England was 1.8 (95% CI 1.7-1.9). CONCLUSIONS: Regional differences in breast surgery have changed very little in 25 years.

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