The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer

Abstract

BACKGROUND: Multiple factors may influence whether patients undergo immediate breast reconstruction along with mastectomy for breast cancer. The authors investigated whether ethnicity was an independent predictor of immediate breast reconstruction. METHODS: The authors identified 1004 patients who underwent mastectomy for breast cancer during the period 2001-2002. The rates of immediate reconstruction among different ethnicities were evaluated using the chi-square test. Logistic regression was used to adjust for covariates, including age and disease stage. Medical records were analyzed to identify factors that influenced each patient\u27s decision for or against immediate breast reconstruction. RESULTS: Three hundred seventy-six women (37.5%) underwent immediate breast reconstruction: This included 20.2% of African-American women, compared with 40.0% of white women, 42.0% of Hispanic women, 42.2% of Asian women, and 10.0% of Middle Eastern women (P \u3c 0.001). The unadjusted odds ratio (OR) for immediate reconstruction for African-Americans versus whites was 0.38 (95% confidence interval [95% CI], 0.23-0.63; P \u3c 0.001). After multivariate analysis, this disparity persisted, with an adjusted OR of 0.34 (95% CI, 0.18-0.62; P = 0.001). Asian women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.50; 95% CI, 0.24-1.04; P = 0.06). Hispanic women did not have immediate reconstruction rates that differed significantly from white women. Middle Eastern women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.08; 95% CI, 0.02-0.38; P = 0.002), but they had a corresponding increase in the rate of delayed reconstruction. In a stepwise analysis of the decision pathway to immediate reconstruction, it was found that African-American women were less likely to be offered referrals for reconstruction, were less likely to accept offered referrals, were less likely to be offered reconstruction, and were less likely to elect reconstruction if it was offered. CONCLUSIONS: African-American women underwent immediate breast reconstruction at significantly lower rates compared with white women, Hispanic women, and Asian women. After adjusting for covariates, including age and disease stage, African-American women and Asian women had lower rates of reconstruction compared with white women. The factors that contribute to these differences warrant further study

Breast reconstruction after mastectomy for breast cancer

“…We identified nine populationbased and five hospital-based studies in the United States describing the care of patients from 1985 through 2007 (Table 2). 12,[15][16][17][18][19][20][21][22][23][24][25][26][27] The rate of breast reconstruction increased from 3.4% in [1985][1986][1987][1988][1989][1990] to 42% in 1997-2002 in a network of tertiary cancer centres. 13,19 We identified six studies from other jurisdictions, four of which were English-language publications (Table 3).…”

“…12,13,16,17,18,[20][21][22][23][24][25][26][27][28]30 This is in part because of concern about increased complication rates with age and comorbidities. In an attempt to identify predictors of breast reconstruction using the hospitalbased national sample of inpatients from 1999-2003, Reuben and colleagues 27 found that the association between age and breast reconstruction remained significant after controlling for comorbidities.…”

“…12,16,19,[20][21][22][23]26,27,33 In a population-based study by Morrow and colleagues 34 involving 1844 women with breast cancer, the authors found that, after controlling for age, stage of disease and level of education, black women underwent breast reconstruction less frequently than white women.…”

Do Variations in Provider Discussions Explain Socioeconomic Disparities in Postmastectomy Breast Reconstruction?

“…As with many other high-cost elective procedures, previous studies have demonstrated racial and socioeconomic variations in the utilization of post-mastectomy reconstruction. [1][2][3][4][5][6][7][8][9][10] Careful review of these studies suggests that the observed racial disparities likely reflect differences in socioeconomic status. In fact, the majority of studies that account for differences in individual SES find that race is not a significant predictor of reconstruction.…”

The Impact of Ethnicity on the Incidence, Tumor Characteristics and Treatment of Ductal Carcinoma <i>in Situ</i>—An 11-Year Clinical Experience at a High Volume Teaching Hospital

“…The mastectomy procedure was based on extent of microcalcification as well as patient choice. Tseng et al reported that African American women were less likely to be offered referrals for reconstruction and African American women along with Asian women had low rates of reconstruction compared with Caucasian women [27].…”