INTRODUCTION:Radiation therapy (RT) is an essential component of treatment for breast cancer (BC), and while indications and delivery techniques evolve, inequities in access remain. Immigrant women face barriers navigating the healthcare system, but impact of immigration status on delivery of adjuvant RT for BC has not been studied. METHODS:A population-level study using provincial databases was conducted including women with Stage I-III breast cancer diagnosed between 2010-2016 in Ontario, Canada undergoing breast conserving surgery (BCS). Co-variates including age, co-morbidity, socioeconomic factors, stage, receptor status and treatment facility factors were collected. Primary outcome was the proportion of women undergoing RT and secondary outcome was time from surgery to RT. RESULTS:Of 30,712 women, 4,293 (14 %) were immigrants. Immigrants were younger (54.6 vs. 62.5 years) and less often had Stage I (49.4 % vs. 57.0 %) disease. Odds of receiving RT after BCS was 0.81 (95 %CI 0.74-0.89p < 0.0001) for immigrant vs. non-immigrant women. When stratified by age, immigrant women < 70 were less likely to receive RT when compared to non-immigrants, while no differences were observed for those ≥ 70. There was a small, though significant difference in mean wait-time from surgery to RT in patients who did not receive chemotherapy [immigrant vs non-immigrant 72.7 days (28.8 SD) vs. 77.7 days (31.0 SD), p < 0.0001]. CONCLUSION:Our study demonstrates a lower proportion of immigrant women receiving RT after BCS compared to non-immigrant women. There was a small difference in wait-time to radiation. Further research is needed to explore system, provider, and patient factors driving this difference.

Appropriate adjuvant radiation therapy (RT) after breast cancer surgery is an important quality of care metric. Cancer treatment experience for immigrant women may differ due to challenges in navigating the health care system. This study compares the proportion of immigrant and Canadian born/long-term resident women receiving adjuvant RT and time to RT. A population-level retrospective cohort-study using linked provincial administrative databases was conducted including women >=18 years of age with Stage I-III breast cancer diagnosed between 2010-2016 in Ontario, Canada. Women were classified as immigrants using the federal database if they arrived in Canada in or after 1985, and as Canadian-born/long-term residents if they were born in Canada or arrived prior to 1985. Dependent variables (age, co-morbidity, socioeconomic factors, stage, and treatments) were collected. Data on proportion of women undergoing RT and time from surgery to RT was collected. Multivariable analysis was performed adjusting for dependent variables. Out of 54,090 patients, 46,930 (86.8%) were Canadian-born/long-term residents and 7,160 (13.2%) were immigrants. Immigrants were younger at diagnosis (54.3 vs. 63.0 years) and more often had Stage III disease (16.8% vs. 13.9%). Odds of receiving RT after breast conserving surgery (BCS) was 0.86 (95% CI 0.78-0.95), and 0.98 (95% CI 0.86-1.12) after mastectomy. Mean time from any surgery to RT was longer for immigrants (126.9 days vs. 117.1 days, p<0.001). Using a multivariable piecewise Cox regression model, excluding patients who received adjuvant chemotherapy before radiation, the hazard ratio for receipt of RT within 90 days for immigrants compared to Canadian long-term residents was 0.87 (95% CI; 0.83-0.92). Amongst immigrants, women from Latin America and the Caribbean had the longest wait times. There were no differences based on length of stay in Canada or immigration class. Our study demonstrates a lower proportion of immigrant women receiving RT after BCS compared to Canadian-born/long-term resident women in Ontario, and a longer wait time for adjuvant RT. Further research is needed to explore system, provider, and patient factors that may be driving this difference.

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

# An assessment of the current state of procedural skills training in Canadian undergraduate medical education {#article-title-2} The objectives of the study were to characterize the procedural skills education currently included in preclerkship and clerkship curricula, to determine what skills