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Evaluating breast cancer surgery ascertainment in England's routine healthcare data: A retrospective cohort study
Liyang Wang1, Diana Withrow1, Christine Delon2
1Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Background:
Real world evidence is increasingly used in population-level breast cancer research, but the validity of procedure recording across routinely collected healthcare datasets in England remains uncertain. Although Hospital Episode Statistics (HES) can be linked to other datasets, reliable capture of surgery in the Cancer Treatments dataset would provide a cancer-specific source that can be used directly alongside tumour characteristics and treatment data. We evaluated capture of breast cancer surgery in the Cancer Treatments dataset with HES.
Methods:
This retrospective study included patients diagnosed with breast cancer in England between 01/01/2015 and 31/12/2023, identified from the National Cancer Registration Dataset. The two datasets were compared for recording of breast cancer surgery, type of surgery, reoperation after breast-conserving surgery (BCS) and capture of oncoplastic BCS procedures and immediate breast reconstruction. Agreement was assessed using percentage agreement, Cohen's kappa, sensitivity and specificity.
Results:
Among 421,949 patients, 337,622 (80.0%) had surgery recorded in the Cancer Treatments dataset and 327,242 (77.6%) in HES. Agreement for recording of first surgery was 94.5% (kappa 0.83), and for type of surgery was 94.0% (kappa 0.90). In 224,418 patients with BCS in both datasets, agreement for reoperation within 12 months was 97.9% (kappa 0.92), with sensitivity 92.6% and specificity 98.9%. However, there was minimal capture of oncoplastic BCS and immediate breast reconstructions in the Cancer Treatments dataset.
Conclusion:
The Cancer Treatments dataset provides robust ascertainment of breast cancer surgery, specifically BCS, mastectomy and re-operation after BCS, but is less reliable for detailed operative information, including oncoplastic BCS procedures and immediate breast reconstruction.
