Surgical management of breast cancer in Australian women in 1993: analysis of Medicare statistics

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Abstract
Objective To examine patterns of surgical management of breast cancer among Australian women. Design Retrospective survey of Medicare records (a national dataset of all services rendered on a “fee‐for‐service” basis for which a Medicare benefit has been paid). Patients All Australian women (4683) who underwent surgery consistent with being for breast cancer in 1993 and for which Medicare benefits were paid. Main outcome measures Proportions of women undergoing different forms of mastectomy, breast‐conserving surgery and axillary surgery by patient age and State and region (urban or rural) of residence. Results Modified radical mastectomy was the most common surgery, performed in 2097 of the 4683 women (44.8%), while 1868 (39.9%) had breast‐conserving surgery. Frequency of breast conservation decreased significantly with age and varied significantly between States and region of residence. It ranged from 34% in Western Australia to 49% in South Australia and the Northern Territory, and from 34% among rural women to 42% among urban women. Axillary surgery was recorded for 83% of all women studied. Conclusions There was substantial geographical variation in patterns of surgical management for breast cancer. The tendency for rural women to undergo mastectomy rather than breast‐conserving surgery may reflect the relative lack of access to postoperative radiotherapy. We are unable to explain the variation between States.