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

Objective: To assess trends in breast surgery, Breast-conserving surgery (BCS) and mastectomy, in an institution with limited access to health resources. Methods: A retrospective cohort study was carried out in patients who underwent surgery for non-metastatic breast cancer between 2012 and 2019 at the Hospital Geral de Fortaleza (HGF), an institution that exclusively treats patients from the Brazilian public health system (SUS). The main objective of the study was to evaluate the rates of mastectomy in the period, with or without immediate reconstruction, as well as BCS rates. The χ2 test, with Bonferroni adjustment, was applied to the relative frequency of the procedures performed to test for statistical significance in the evolution of the frequencies of surgeries over the years. Results: A total of 805 patients underwent surgical treatment for non-metastatic 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 (p=0.04281) and mastectomies. Conclusion: There was no increase in the rates of mastectomies, with and without immediate reconstruction, over the years, but a trend towards an increase in BCS. Further studies are needed to better understand this trend in settings with limited access to health care.