Background: Breast cancer is the most common cancer affecting females in Canada, and about half of females with breast cancer are treated with mastectomy. We sought to evaluate geographic variation in breast reconstruction surgery in Alberta, Canada.Methods: Using linked population-based administrative databases, we extracted data on all Alberta females aged 18 years and older who were diagnosed with breast cancer and treated with mastectomy during 2004-2017. Analyses included regression modelling of odds of reconstruction at 1 year and a spatial scan to identify geographic clusters of lower numbers of reconstruction.Results: A total of 16 198 females diagnosed with breast cancer were treated with a mastectomy, and 1932 (11.9%) had reconstruction within 1 year postmastectomy. Those with reconstruction were more likely to be younger (adjusted odds ratio [OR] 16.7, 95% confidence interval [CI] 13.7-20.3; aged 21-44 yr v. >= 65 yr) and were less likely to be from lower-income neighbourhoods. They were more likely to have at least 1 comorbidity and were more likely to have advanced stages of cancer and to require chemotherapy (adjusted OR 0.55, 95% CI 0.47-0.65) or radiotherapy after mastectomy (adjusted OR 0.59, 95% CI 0.39-0.87) than females without reconstruction. We identified rural northern and southeastern clusters with frequencies of reconstruction that were 69.6% and 41.6% of what was expected, respectively.Conclusion: We found an overall postmastectomy rate of breast reconstruction of 11.9%, and we identified geographic variation. Predictors of reconstruction in Alberta were similar to those previously described in the literature, specifically with patients in rural communities having lower rates of reconstruction than their urban counterparts. These results suggest that further interventions are required to identify the specific barriers to reconstruction within rural communities and to create strategies to ensure equitable access to all residents. Contexte: Le cancer du sein est le cancer le plus r & eacute;pandu chez la population f & eacute;minine au Canada, et pr & egrave;s de la moiti & eacute; des femmes qui en souffrent subissent une mastectomie. Nous avons voulu v & eacute;rifier les variations g & eacute;ographiques pour ce qui est du recours & agrave; la reconstruction mammaire en Alberta, au Canada.M & eacute;thodes: & Agrave; partir de bases de donn & eacute;es administratives populationnelles, nous avons extrait les donn & eacute;es sur toutes les Albertaines de 18 ans et plus ayant re & ccedil;u un diagnostic de cancer du sein trait & eacute; pas mastectomie entre 2004 et 2017. Les analyses ont inclus des mod & egrave;les de r & eacute;gression des risques appliqu & eacute;s & agrave; la reconstruction & agrave; 1 an et un survol g & eacute;ographique visant & agrave; identifier les r & eacute;gions o & ugrave; les chirurgies pour reconstruction ont & eacute;t & eacute; moins nombreuses.R & eacute;sultats: En tout, 16 198 cas de cancer du sein ont & eacute;t & eacute; trait & eacute;s par mastectomie, et 1932 (11,9 %) ont fait l'objet d'une reconstruction au cours de l'ann & eacute;e suivante. Les femmes ayant subi une reconstruction & eacute;taient plus susceptibles d'& ecirc;tre jeunes (rapport des cotes [RC] ajust & eacute; 16,7, intervalle de confiance [IC] de 95 % 13,7-20,3; & acirc;ge 21-44 ans c. >= 65 ans, et moins susceptibles de provenir de milieux d & eacute;favoris & eacute;s. Elles & eacute;taient plus susceptibles de pr & eacute;senter au moins 1 comorbidit & eacute; et un stade de cancer plus avanc & eacute;, et de n & eacute;cessiter une chimioth & eacute;rapie (RC ajust & eacute; 0,55, IC de 95 % 0,47-0,65) ou de la radioth & eacute;rapie apr & egrave;s leur mastectomie (RC ajust & eacute; 0,59, IC de 95 % 0,39-0,87) que les femmes n'ayant pas subi de reconstruction. Nous avons rep & eacute;r & eacute; des agr & eacute;gats dans les r & eacute;gions rurales du nord et du sud-est o & ugrave; la fr & eacute;quence des reconstructions repr & eacute;sentait respectivement de 69,6 % et 41,6 % des valeurs attendues.Conclusion : Nous avons observ & eacute; un taux global de reconstruction post-mastectomie de 11,9 %, ainsi qu'une variation g & eacute;ographique. Les pr & eacute;dicteurs de la reconstruction en Alberta & eacute;taient similaires & agrave; ceux qui avaient d & eacute;j & agrave; & eacute;t & eacute; d & eacute;crits dans la litt & eacute;rature, particuli & egrave;rement dans les communaut & eacute;s rurales o & ugrave; les taux de reconstruction & eacute;taient moindres que dans les milieux urbains. Ces r & eacute;sultats donnent & agrave; comprendre que d'autres interventions sont requises pour mettre au jour les obstacles sp & eacute;cifiques & agrave; la reconstruction dans les communaut & eacute;s rurales et pour & eacute;laborer des strat & eacute;gies qui assureront un acc & egrave;s & eacute;quitable & agrave; toute la population.
