Disparities Persist in the Use of Breast Reconstruction: A Study of one NCI Center’s Tumor Registry Data from 2000-2014
Charalampos Siotos, MD, Ricardo J. Bello, MD, MPH, Rachael M. Payne, BS, Mohamad E. Sabei, MBBS, Mehran Habibi, MD, Kristen P. Broderick, MD, Oluseyi Aliu, MD, MS, Carisa M. Cooney, MPH, Gedge D. Rosson, MD.
Johns Hopkins University, Baltimore, MD, USA.
PURPOSE: Breast reconstruction is a safe option for women undergoing mastectomy after breast cancer, with proven benefits to quality-of-life. Previous studies have documented disparities in the use of breast reconstruction by patient race, insurance type, and age, mostly in cross-sectional studies. This study aimed to estimate disparities over time in the use of breast reconstruction by race/ethnicity, insurance type, and age.
METHODS: We analyzed data from our institution’s prospectively collected National Cancer Institute-Designated Comprehensive Cancer Center Tumor Registry. We used the Chi-squared test and multivariable logistic regression to estimate associations between race/ethnicity, insurance type, age, and breast reconstruction rate. Likelihood-ratio tests assessed the interaction between these associations and period of surgery.RESULTS: From 2000 to 2014, 2,599 women underwent mastectomy for breast cancer. Of these, 1,052 (40.5%) underwent mastectomy only and 1,547 (59.5%) also underwent breast reconstruction. Most reconstructions were autologous (65.1%), followed by implant-based (26.8%), and mixed (8.1%). A multivariable logistic regression model showed that higher cancer stage (p<0.001), being older (p<0.001), smoking status (p<0.007), African-American (p<0.001) or Asian (p<0.001) race, having Medicare (p<0.001) or Medicaid (p=0.044) coverage, and being uninsured (p=0.019) were significant and independent risk factors for not receiving breast reconstruction after mastectomy (Table 1). We found no evidence that disparities based on age, race/ethnicity, or insurance type changed over the study period (p>0.050). Cancer stage, age, race/ethnicity, or insurance type were not significant predictors for type of reconstruction (p>0.050). CONCLUSION: Despite being a tertiary and quaternary clinical center with a comprehensive approach to breast cancer care, our findings demonstrate disparities in use of breast reconstruction according to women’s age, race/ethnicity, and insurance type. Furthermore, these disparities did not change significantly over the study period. Given the recent and anticipated changes associated with the Affordable Care Act, it is more important than ever to identify the reasons behind these differences and continue to evaluate barriers in access to breast reconstruction.
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