Socioeconomic and Geographic Differences in Immediate Reconstruction after Mastectomy in the United States

Abstract

Disparities are evident in breast cancer diagnosis, treatment, and outcomes. This study examines multiple socioeconomic and geographic regions across the US to determine if disparities exist in the type of reconstruction obtained after mastectomy. This is a retrospective study evaluating socioeconomic and geographic variables of 14,764 women who underwent mastectomy in 2008 using the Nationwide Inpatient Sample (NIS). Statistical analysis was performed on three groups of women: patients without reconstruction (NR), patients who underwent breast implant/tissue expander reconstruction (TE), and patients with autologous reconstruction such as free or pedicled flaps (FLAP). The majority of patients (63.9%) had NR, while 23.9% had TE and 12.2% underwent FLAP. Compared to patients with NR, women with TE or FLAP were younger (64.9 years versus 51.3 and 51.1 years, p < 0.001), had fewer chronic conditions (2.60 and 2.54 chronic conditions for TE and FLAP respectively versus 3.85 for NR, p < 0.001) and higher mean hospital charges ($42,850 TE and $48,680 FLAP versus $22,300 NR, p < 0.001). Both Medicare and Medicaid insurance carriers had a higher proportion of women that did not get reconstructed compared to other insurance types (p < 0.001). Compared to NR, reconstructed women more often lived in urban areas and zip codes with higher average incomes (p < 0.001). This is the first national study analyzing insurance type and geographic variations to show statistically significant disparities in rate and type of immediate reconstruction after mastectomy. These inequalities need to be addressed to extend immediate reconstruction options to all women undergoing mastectomy.

Predictors for Reconstruction and Mood Disorder Associated With Reconstruction in Patients With Breast Cancer and Mastectomy

“…21–24 A cross-sectional study of women with early stage breast cancer identified factors affecting BCT versus mastectomy choice and found that age >70 years, rural location, and lack of insurance were the strongest predictors for mastectomy and not receiving adjuvant radiotherapy. 22 Dragun et al examined factors influencing the receipt of mastectomy and found that determinants of higher rates of mastectomy for in situ and early stage breast cancer included stage, moderate or poorly differentiated histology, ages older than 70 years, uninsured and government-insured, rural location, receptor negative disease.…”

“…Additionally, Wexelman et al 21 who conducted a study of women who underwent mastectomy in the United States indicated that reconstructed women tended to be younger, have fewer chronic illnesses, more often living in urban areas and have higher incomes, as compared with those without reconstruction. Sio et al 25 also noted that young women were more likely than old women to receive aggressive therapies and have better physical functioning.…”

Geographic variations in racial disparities in postmastectomy breast reconstruction: A SEER database analysis

“…Women who undergo PMBR generally live in urban areas and within zip codes with higher than average incomes . While it is known that disparities are multifactorial, investigating interaction of factors is paramount to gaining a better understanding of the obstacles to breast reconstruction.…”

“…4,5,7 Women who undergo PMBR generally live in urban areas and within zip codes with higher than average incomes. 8 While it is known that disparities are multifactorial, investigating interaction of factors is paramount to gaining a better understanding of the obstacles to breast reconstruction. To our knowledge, there are no existing studies that examine the interaction between geographic and racial differences in the rate of immediate reconstruction after mastectomy.…”

Disparities in Immediate Breast Reconstruction after Mastectomy: Time for a Change

“…In this issue of The Breast Journal, Wexelman et al . from St. Luke's‐Roosevelt Hospital in New York report on disparities in immediate breast reconstruction performed based on the Nationwide Inpatient Sample data‐base from over 1000 hospitals in 42 states . This is the largest analysis of disparities in reconstruction rates among race, socioeconomic class, and geographic location to date.…”