Sydney Cancer Conference, 2016

Equity implications of uncoordinated health data collection systems: The case of breast reconstruction in Australia

Kathy Flitcroft, Meagan Brennan and Andrew Spillane.


Kathy Flitcroft presented research on the difficulties of accessing data on breast reconstruction (BR) in Australia to the Sydney Cancer Conference in September. Her presentation highlighted the deficiencies in data collected by Medicare Australia, the Australian Institute of Health and Welfare (both funded by the Australian government) and the Breast Surgeons of Australia and New Zealand Inc. (BreastSurgANZ). No one source of BR data provided full coverage of all women who had undergone BR following breast cancer. Problems identified included: lack of specific procedural descriptors for BR; differences in data coverage (which hospitals, patients and cancers are included); differences in procedural descriptors used (Item numbers versus ICD_10 codes); jurisdictional variations and cross-border patient issues; and lack of local data due to privacy concerns.

Regional mapping of breast reconstruction, using the only source of hospital-based data available—the BreastSurgANZ Quality Audit (BQA) database—revealed possible sources of disparities in BR uptake between capital city and non-capital city areas and within capital city areas. These findings indicate that variation in uptake of BR is not likely to be solely resource-driven – if a hospital/surgeon can perform a mastectomy, why not a BR? We hypothesised that surgeons’ attitudes towards performing BR, or facilitating BR through referrals if they lack the skills to perform BR themselves, are likely to be the most significant factors to explain variation within capital city areas.