Racial Disparity in Immediate Breast Reconstruction; a Gap That is not Closing

Abstract

Background: Immediate breast reconstruction (IBR) is offered as part of the standard-of-care to females undergoing mastectomy. Racial disparity in IBR has been previously reported with a longstanding call for its elimination, though unknown if this goal is achieved. The aim of this study was to examine the current association between race and IBR and to investigate whether racial disparity is diminishing. Methods: Data was extracted from the National Cancer Database (NCDB) from 2004 to 2016. All variables in the database were controlled so that the comparison would be made solely between Black and White females. We also analyzed the trend in racial disparity to see if there has been a change from 2004 to 2016 after several calls for healthcare equality. Results: After propensity score matching, 69,084 White females were compared to 69,084 Black females. There was a statistically significant difference between the rate of IBR and race (23,386 [33.9%] in White females vs 20,850 [30.2%] in Black females, P-value < .001). Despite a twofold increase in the rate of IBR in both White and Black females, a persistent gap of about 4% was observed over the study period, which translates to more than 2,500 Black females not receiving IBR. Conclusions: Using the NCDB database, a racial disparity was identified for IBR between White and Black females from 2004 and 2016. Unfortunately, the gap between the groups remained constant over this 13-year period.

Mind the Gap

“…Authors Malekpour et al should be congratulated on pursuing this important topic in the setting of postmastectomy reconstruction. 1 Encouragingly, their group demonstrated a twofold increase in the rate of immediate breast reconstruction in all-comers over the period from 2004 through 2016, likely a direct result of increased legislative support, insurance coverage, and general awareness of breast reconstructive options. Importantly, however, their study noted a persistent gap of 4% in the rate of reconstruction between White and Black women with Black women consistently less likely to undergo breast reconstruction over the 13-year study period.…”