Racial Disparities in Immediate Breast Reconstruction After Mastectomy: Impact of State and Federal Health Policy Changes

Yang, Rachel; Newman, Andrew S.; Reinke, Caroline E.; Lin, Ines C.; Karakousis, Giorgos C.; Czerniecki, Brian J.; Wu, Liza C.; Kelz, Rachel R.

doi:10.1245/s10434-012-2607-9

Cited by 49 publications

(33 citation statements)

References 30 publications

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“…Our findings extend other studies that have identified disparities in receipt of breast reconstruction 10–24 by demonstrating not only that the gap in receipt of reconstruction is evident in a contemporary patient cohort but also that the disparity has not narrowed over time. Given the known benefits associated with receipt of immediate breast reconstruction, 1–4 it is critical that we as a surgical community move beyond simply describing that sociodemographic factors are associated with disparate care to understanding how these factors lead to the gaps in care in order to improve the quality of breast cancer care for disadvantaged patient populations.…”

Section: Discussionsupporting

confidence: 85%

“…10–24 Our model, adapted from the Behavioral Change Wheel, 31 posits that whether or not a patient undergoes reconstruction is determined by her Capability , Motivation , and Opportunity (Figure 2). Capability includes clinical factors that determine whether a patient is a good candidate for reconstruction, such as recommendation for post-mastectomy radiation or active smoking.…”

Section: Discussionmentioning

confidence: 99%

“…10–14 However, although overall rates of reconstruction have increased, substantial variation exists regarding who undergoes reconstruction. 10–24 Breast reconstruction following mastectomy is an elective component of breast cancer treatment and reconstruction is not the right choice for everyone. Patient preference or clinical factors rendering the patient a poor candidate for the procedure (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…However, prior studies evaluating patients diagnosed with breast cancer in the early 2000’s have suggested disparities in the receipt of immediate reconstruction by socioeconomic factors such as race, income, education-level and insurance. 10–24 The objective of this study was to evaluate national rates of immediate post-mastectomy reconstruction and examine socioeconomic factors associated with receipt of reconstruction in a contemporary cohort.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic Factors Associated with Post-Mastectomy Immediate Reconstruction in a Contemporary Cohort of Breast Cancer Survivors

et al. 2017

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Background Post-mastectomy reconstruction is a critical component of high-quality breast cancer care. Prior studies demonstrate socioeconomic disparity in receipt of reconstruction. Our objective was to evaluate trends in receipt of immediate reconstruction and examine socio-economic factors associated with reconstruction in a contemporary cohort. Methods Using the National Cancer Database, we identified women < 75 years of age with stage 0-1 breast cancer treated with mastectomy (n=297,121). Trends in immediate reconstruction rates (2004-2013) for the overall cohort and stratified by socioeconomic factors were examined using Join-point regression analysis. Annual percent change (APC) was calculated. We then restricted our sample to a contemporary cohort (2010-2013, n=145,577). Multivariable logistic regression identified socioeconomic factors associated with immediate reconstruction. Average adjusted predicted probabilities of receiving reconstruction were calculated. Results Immediate reconstruction rates increased from 27% to 48%. Although absolute rates of reconstruction for each stratification group increased, similar APC’s across strata led to persistent gaps in receipt of reconstruction. On multivariable logistic regression using our contemporary cohort, race, income, education, and insurance type were all strongly associated with immediate reconstruction. Patients with the lowest predicted probability of receiving reconstruction were patients with Medicaid who live in areas with the lowest rates of high school graduation (black 42.4 (40.5-44.3)%, white 45.7 (43.9-47.4)%). Conclusions Although reconstruction rates have increased dramatically over the past decade, lower rates persist for disadvantaged patients. Understanding how socioeconomic factors influence receipt of reconstruction and identifying modifiable factors are critical next steps towards identifying interventions to reduce disparities in breast cancer surgical care.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Socioeconomic Factors Associated with Post-Mastectomy Immediate Reconstruction in a Contemporary Cohort of Breast Cancer Survivors

et al. 2017

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“…As the reported rate of synchronous breast cancer is less than 1%, we made the assumption that nearly all the bilateral mastectomies performed had one side that was prophylactic. [17][18][19] Conclusions Despite the higher risks for complications associated with BM and IBR and despite the availability of breast conservation therapy, rates of BM and associated IBR have been rising since 2005. Younger white patients are most likely to choose the most aggressive surgical management of their breast cancer and subsequent reconstruction.…”

Section: Commentsmentioning

confidence: 99%

National trends and complication rates after bilateral mastectomy and immediate breast reconstruction from 2005 to 2012

Kwok

Goodwin

Jin

et al. 2015

The American Journal of Surgery

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Regional Implicit Racial Bias and Rates of Breast Reconstruction, Complications, and Cost Among US Patients With Breast Cancer

et al. 2023

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ImportanceRacial disparities influencing breast reconstruction have been well-researched; however, the role of implicit racial bias remains unknown. An analysis of the disparities in care for patients with breast cancer may serve as a policy target to increase the access and quality of care for underserved populations.ObjectiveTo identify whether variations in implicit racial bias by region are associated with the differences in rates of immediate breast reconstruction, complications, and cost for White patients and patients from minoritized racial and ethnic groups.Design, Setting, and ParticipantsThis cohort study used data from the National Inpatient Sample (NIS) from 2009 to 2019. Adult female patients with a diagnosis of or genetic predisposition for breast cancer receiving immediate breast reconstruction at the time of mastectomy were included. Patients receiving both autologous free flap and implant-based reconstruction were included in this analysis. US Census Bureau data were extracted to compare rates of reconstruction proportionately. The Implicit Association Test (IAT) was used to classify whether implicit bias was associated with the primary outcome variables. Data were analyzed from April to November 2022.ExposureIAT score by US Census Bureau geographic region.Main Outcomes and MeasuresVariables of interest included demographic data, rate of reconstruction, complications (reconstruction-specific and systemic), inpatient cost, and IAT score by region. Spearman correlation was used to determine associations between implicit racial bias and the reconstruction utilization rate for White patients and patients from minoritized racial and ethnic groups. Two-sample t tests were used to analyze differences in utilization, complications, and cost between the 2 groups.ResultsA total of 52 115 patients were included in our sample: 38 487 were identified as White (mean [SD] age, 52.0 [0.7] years) and 13 628 were identified as minoritized race and ethnicity (American Indian, Asian, Black, and Hispanic patients and patients with another race or ethnicity; mean [SD] age, 49.7 [10.5] years). Implicit bias was not associated with disparities in breast reconstruction rates, complications, or cost. Nonetheless, the White-to–minoritized race and ethnicity utilization ratio differed among the regions studied. Specifically, the reconstruction ratio for White patients to patients with minoritized race and ethnicity was highest for the East South Central Division, which includes Alabama, Kentucky, Mississippi, and Tennessee (2.17), and lowest for the West South Central Division, which includes Arkansas, Louisiana, Oklahoma, and Texas (0.75).Conclusions and RelevanceIn this cohort study of patients with breast cancer, regional variation of implicit bias was not associated with differences in breast reconstruction utilization, complications, or cost. Regional disparities in utilization among racial and ethnic groups suggest that collaboration from individual institutions and national organizations is needed to develop robust data collection systems. Such systems could provide surgeons with a comparative view of their care. Additionally, collaboration with high-volume breast centers may help patients in low-resource settings receive the desired reconstruction for their breast cancer care, helping improve the utilization rate and quality of care.

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Racial Disparities in Immediate Breast Reconstruction After Mastectomy: Impact of State and Federal Health Policy Changes

Cited by 49 publications

References 30 publications

Socioeconomic Factors Associated with Post-Mastectomy Immediate Reconstruction in a Contemporary Cohort of Breast Cancer Survivors

Socioeconomic Factors Associated with Post-Mastectomy Immediate Reconstruction in a Contemporary Cohort of Breast Cancer Survivors

National trends and complication rates after bilateral mastectomy and immediate breast reconstruction from 2005 to 2012

Regional Implicit Racial Bias and Rates of Breast Reconstruction, Complications, and Cost Among US Patients With Breast Cancer

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