Trends in mastectomy for early breast cancer in a public institution with limited access: a retrospective cohort

Abstract

Introduction: Breast-conserving surgery (BCS) is the preferred surgical treatment for early breast cancer. However, there
has been an increase in mastectomies in developed countries in recent years. Not much is known, though, about this trend
in breast healthcare in low- and middle-income countries. Objective: This study aimed to evaluate the rates of mastectomy,
with or without immediate reconstruction, as well as BCS. Methods: This is a retrospective cohort study of patients who
underwent surgery for non-metastatic breast cancer between 2012 and 2019 at the Hospital Geral de Fortaleza, an institution that exclusively treats patients from the Brazilian Unified Health System (SUS). The chi-square test, with Bonferroni
adjustment, was applied to the relative frequencies of the procedures performed in order to test statistical significance in
the evolution of surgery frequencies over the years. Results: A total of 805 patients underwent surgical treatment for nonmetastatic breast cancer, with an average of 100 surgeries per year (range 85–118) during the study period. Mastectomy
was performed in 552 cases (68.57%), while 253 patients underwent BCS (31.42%). Among the patients who underwent mastectomy, 181 (32.78%) had immediate reconstruction, with the highest proportion using implants (92.26%). No statistical
difference was observed between mastectomies with or without reconstruction throughout the period (p=0.6635), with a
statistically significant difference between BCS and mastectomies (p=0.0428). Conclusion: No increase in mastectomy
rates, with and without immediate reconstruction, was observed over the years, but a trend towards an increase in BCS
was identified. Further studies are needed to better understand this trend in settings with limited access to health care.