Abstract 92: Immediate Breast Reconstruction in Alberta: A Canadian Perspective
Bibliographic record
Abstract
PURPOSE: The aim of this study is to assess the variations in immediate breast reconstruction (IBR) in the province of Alberta, Canada. More specifically, we sought to determine the rate of IBR and to understand the wait time differences that exist between urban and rural hospital settings and trends in reconstruction type. METHODS: A patient database was created using a provincial cancer registry database cross referenced with the National Ambulatory Care Reporting System and the Discharge Abstract Database. Appropriate mastectomy and breast reconstruction codes were identified using procedure codes outlined in the Canadian Classification of Health Interventions. Women diagnosed with ductal carcinoma in situ or invasive carcinomas between the fiscal years 2005–2015 were included. Immediate breast reconstruction patients were then identified and patient demographic data, breast reconstruction details, and geographical information were obtained. Rural and urban populations were defined using Canada Statistical Guidelines for further analysis. RESULTS: In the ten-year time period examined, 9,373 breast cancer patients underwent mastectomy in Alberta. There were 1,568 (16.7%) patients with delayed reconstruction, 547 (5.8%) patients with immediate reconstruction and 7,258 (77.5%) patients without breast reconstruction. Compared to women not undergoing reconstruction, IBR patients were significantly younger (48.4 vs. 62.7, p<0.001). Fewer women undergoing IBR required RT (60/547, 11.0%) compared to women who did not undergo reconstruction (2166/7258, 29.8%, p<0.001) and AJCC staging tended to be lower in women undergoing IBR. There were 76 (2.8%) women living in rural and 471 (6.7%) in urban areas who underwent IBR. Average age of rural and urban women were similar (49.1 vs. 48.3, p=0.05). Time from breast cancer diagnosis to mastectomy and reconstruction was an average of 14.7 for rural women vs. 14.5 weeks for urban women (p=0.9) and both waited similar times for flap or implant-based reconstruction. In relation to type, implant-based reconstruction was more common in both patient populations (p<0.01). CONCLUSION: Differences in breast reconstruction patterns based on demographic factors have been described in the literature. This study of a large North American patient population highlights such differences. Younger women with better prognostic factors who live in urban settings have higher rates of immediate breast reconstruction. Knowledge of this can help us to mitigate these disparities by improving access to immediate breast reconstruction for certain populations. J.P. Stone: None. S. Sarmiento: None. J. Bu: None. D. Bhat: None. C. Temple-Oberle: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".