Geographic variations in surgical treatment for breast cancer: a systematic review

Abstract

We conducted a systematic review with the aim of synthesising and examining existing evidence on geographic variations in the type of surgery received for invasive breast cancer. Our focus was on the alternatives of mastectomy or breast conserving surgery followed by radiotherapy. Studies were considered for inclusion if they involved women diagnosed with early invasive breast cancer (stage I-IIIA), were population-based or institution-based, assessed variations in the type of surgical treatment received based on area-level indices such as urban/rural status, accessibility (availability of and proximity to cancer services) and socioeconomic status, and published the findings in English as a full text article. The literature search was carried out from 29 November 2018 to 06 December 2018. Seven electronic databases were systematically searched, 3,109 citations screened, and 40 studies included. The studies were conducted in the United States (US) [31], Canada, China, Japan, and Australia and varied widely in terms of the patient population and geographic measures used. Significant and consistent disparities were found across various geographic locations, with breast conserving surgery being more often received by patients living in urban areas, in areas with better accessibility to cancer care and in areas of higher socioeconomic status. Our findings underscore the need for more efforts to address geographic disparities in breast cancer care. Most studies were from the US, and none from low- or middle-income countries.