Influence of race, insurance status, and geographic access to plastic surgeons on immediate breast reconstruction rates

Butler, Paris D.; Familusi, Olatomide; Serletti, Joseph M.; Fox, Justin P.

doi:10.1016/j.amjsurg.2017.09.037

Cited by 46 publications

(36 citation statements)

References 35 publications

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“…The results of our study resonate with similar findings in the literature, where women with lower income and without insurance demonstrated comparable disparities in breast cancer care, which translate to lower survival rates . For example, Coburn et al found that privately insured women more often presented at a younger age and with earlier stage disease, which allows for more timely management.…”

Section: Discussionsupporting

confidence: 90%

“…For example, Coburn et al found that privately insured women more often presented at a younger age and with earlier stage disease, which allows for more timely management. Other studies have demonstrated an association between poor insurance coverage and low rates of reconstruction, with authors consistently finding uninsured patients and those with government‐funded health care to be significantly less likely to undergo immediate breast reconstruction . Lower survival rates have been demonstrated in previous studies for women who report lower socioeconomic status .…”

Section: Discussionmentioning

confidence: 93%

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Association between socioeconomic factors and outcomes in breast cancer

et al. 2019

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Background: Persistent socioeconomic disparities are evident in the delivery of health care. Despite previous research into health disparities, the extent of the effect of economic inequalities in the management of breast cancer is not well understood.The purpose of our study is to perform a national assessment of the impact of economic factors on key aspects of breast cancer management.Methods: This is a retrospective study using data from the National Cancer Database.The population consisted of female patients with primary breast cancer diagnosed between 2011 and 2015. Patients were categorized based on household income and insurance status. Outcomes investigated were stage at diagnosis, rate of breast conservation therapy, use of immediate reconstruction following mastectomy, and administration of systemic therapy for stage 3 and 4 disease. Multivariable logistic regression analyses were performed to determine significant associations between economic factors and clinical outcomes. Survival analysis was performed to evaluate the influence of income and insurance on survival. Results:In total, 666 487 women were evaluated. Multivariable regression analyses revealed that patients with lower income (OR, 1.23) and no insurance (OR, 1.64) were more often diagnosed with later stage disease. Patients with lower income (OR, 1.08) and no insurance (OR, 1.05) had a higher likelihood of undergoing mastectomy instead of breast conserving therapy. Patients with lower income (OR, 0.51) and no insurance (OR, 0.27) were less likely to receive immediate breast reconstruction.Administration of systemic therapy was less frequent in patients with lower income (OR, 0.90) and no insurance (OR, 0.52). A survival benefit was demonstrated in patients with high income and insurance. Conclusion:Our findings demonstrate prevailing disparities in the delivery of care among patients with limited economic resources, which pertains to some of the most important aspects of breast cancer care. The full etiology of the observed disparities is complex and multifactorial, and a better understanding of these issues offers the potential to close the existing gap in quality of care. K E Y W O R D Sbreast cancer, care, outcomes, socioeconomic factors | 489 RIBA et Al.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 93%

Association between socioeconomic factors and outcomes in breast cancer

et al. 2019

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“…It has been noted that therapeutically appropriate interventions, including breast reconstruction and gene expression profile testing, can drive some treatment delays; however, because reconstruction and gene expression profile testing are used at similar rates or lower rates among black women and complications of breast reconstruction are similar across race, such clinically appropriate delays are unlikely to explain the racial disparities that we have observed. Some previous literature has suggested that racial disparities in breast cancer treatment quality and timeliness may partially be explained by the characteristics of the institutions at which minority patients seek care, their insurance status, and/or the distribution of minority patients in geographic areas with lower access or longer distance to care .…”

Section: Discussionmentioning

confidence: 72%

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study

Reeder‐Hayes

Mayer

Olshan

et al. 2019

Cancer

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Background After controlling for baseline disease factors, researchers have found that black women have worse breast cancer survival, and this suggests that treatment differences may contribute to poorer outcomes. Delays in initiating and completing treatment are one proposed mechanism. Methods Phase 3 of the Carolina Breast Cancer Study involved a large, population‐based cohort of women with incident breast cancer. For this analysis, we included black women (n = 1328) and white women (n = 1331) with stage I to III disease whose treatment included surgery with or without adjuvant therapies. A novel treatment pathway grouping was used to benchmark the treatment duration (surgery only, surgery plus chemotherapy, surgery plus radiation, or all 3). Models controlled for the treatment pathway, age, and tumor characteristics and for demographic factors related to health care access. Exploratory analyses of the association between delays and cancer recurrence were performed. Results In fully adjusted analyses, blacks had 1.73 times higher odds of treatment initiation more than 60 days after their diagnosis in comparison with whites (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.04‐2.90). Black race was also associated with a longer treatment duration. Blacks were also more likely to be in the highest quartile of treatment duration (OR, 1.69; 95% CI, 1.41‐2.02), even after adjustments for demographic and tumor characteristics (OR, 1.31; 95% CI, 1.04‐1.64). A nonsignificant trend toward a higher recurrence risk was observed for patients with delayed initiation (hazard ratio, 1.44; 95% CI, 0.89‐2.33) or the longest duration (hazard ratio, 1.17; 95% CI, 0.87‐1.59). Conclusions Black women more often had delayed treatment initiation and a longer duration than whites receiving similar treatment. Interventions that target access barriers may be needed to improve timely delivery of care.

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“…timing and suitability for reconstruction, and preferred method such as implants alone versus use of LD flaps). Regional differences have also been reported in the USA, where up to 84% of Caucasian women in areas with a high density of plastic surgeons and private insurance undergo immediate reconstruction …”

Section: Discussionmentioning

confidence: 89%

Surgical treatment of early stage breast cancer in the Auckland and Waikato regions of New Zealand

Campbell

Lao

Blackmore

et al. 2018

ANZ Journal of Surgery

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Background: The aim of this study was to understand the factors influencing the use of surgical options by New Zealand women with newly diagnosed breast cancer. Methods: Using data from the Auckland and Waikato breast cancer registers, we included 11 798 women diagnosed with stage I-III breast cancer from June 2000 to May 2013. The characteristics of women receiving different surgical treatments and having immediate breast reconstruction following mastectomy were examined. A logistic regression was used to estimate the odds ratio of having breast-conserving surgery (BCS) versus mastectomy and immediate post-mastectomy reconstruction. Bilateral breast cancer cases and women with unilateral breast cancer, but who had bilateral surgery, were also identified. Results: Fifty-two percent of women received BCS and 44% had mastectomy over the study period. Key influences associated with BCS were age, mode of diagnosis, socioeconomic status and public or private treatment. Just under half of the women who underwent bilateral surgery did not have bilateral cancer. Nineteen percent of women undergoing mastectomy underwent immediate reconstruction. Implant use increased slightly over the study period but there was a decrease in the use of autologous flap procedures. Conclusion: Surgical management of women with localized breast cancer was generally in line with guidelines, but with potential to further increase the use of breast conservation and immediate reconstruction in suitable cases.

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Influence of race, insurance status, and geographic access to plastic surgeons on immediate breast reconstruction rates

Cited by 46 publications

References 35 publications

Association between socioeconomic factors and outcomes in breast cancer

Association between socioeconomic factors and outcomes in breast cancer

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study

Surgical treatment of early stage breast cancer in the Auckland and Waikato regions of New Zealand

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