Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2013

01-02-2013 | Healthcare Policy and Outcomes

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

Authors: Rachel L. Yang, BA, Andrew S. Newman, MD, Caroline E. Reinke, MD, MSPH, Ines C. Lin, MD, Giorgos C. Karakousis, MD, Brian J. Czerniecki, MD, PhD, Liza C. Wu, MD, Rachel R. Kelz, MD, MSCE

Published in: Annals of Surgical Oncology | Issue 2/2013

Login to get access

Abstract

Background

Federal and Pennsylvania state policies instituted in the late 1990s were designed to improve access to postmastectomy breast reconstruction. We sought to evaluate the impact of these policy changes on access to care among racial minorities.

Methods

Mastectomy patients ≥18 years old were identified in the Pennsylvania Health Care Cost Containment Council inpatient database (1994–2004) and classified by immediate breast reconstruction (IBR) status. Rates of IBR were calculated by patient characteristics and year. Patients were stratified by race before (1994–1997) and after (2001–2004) policy changes, and relative odds of IBR were estimated by univariate and multivariate logistic regression analyses with adjustment for known confounders.

Results

Overall rates of IBR were significantly higher in the time period after policy change compared to before policy change (18.5 vs. 32.7 %, p < 0.01). White, black, and Asian patients all saw a significant rise in rates of IBR. However, after adjustment for potential confounders, black patients, Asian patients, and those of mixed or other races all remained less likely to undergo IBR when compared to white patients after policy changes (odds ratio [OR] 0.66, 95 % confidence interval [CI] 0.55–0.80; OR 0.30, 95 % CI 0.18–0.49; OR 0.29, 95 % CI 0.16–0.51, respectively).

Conclusions

Rates of IBR increased across all racial groups after policy changes. However, not all races were affected equally, and thus disparities remained. Future studies are needed to investigate the role of other factors, including cultural preferences in utilization of IBR that might explain residual disparities.
Literature
1.
2.
Stevens LA, McGrath MH, Druss RG, Kister SJ, Gump FE, Forde KA. The psychological impact of immediate breast reconstruction for women with early breast cancer. Plast Reconstr Surg. 1984;73:619–28.PubMedCrossRef
3.
Schain WS. Breast reconstruction. Update of psychosocial and pragmatic concerns. Cancer. 1991;68:1170–5.PubMedCrossRef
4.
Downes KJ, Glatt BS, Kanchwala SK, et al. Skin-sparing mastectomy and immediate reconstruction is an acceptable treatment option for patients with high-risk breast carcinoma. Cancer. 2005;103:906–13.PubMedCrossRef
5.
Polednak AP. Geographic variation in postmastectomy breast reconstruction rates. Plast Reconstr Surg. 2000;106:298–301.PubMedCrossRef
6.
DeSantis C, Siegel R, Bandi P, Jemal A. Breast cancer statistics, 2011. CA Cancer J Clin. 2011;61:408–18.CrossRef
7.
8.
Wilkins EG, Alderman AK. Breast reconstruction practices in North America: current trends and future priorities. Semin Plast Surg. 2004;18:149–55.PubMedCrossRef
9.
10.
Morrow M, Mujahid M, Lantz PM, et al. Correlates of breast reconstruction: results from a population-based study. Cancer. 2005;104:2340–6.PubMedCrossRef
11.
Alderman AK, McMahon L Jr, Wilkins EG. The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors. Plast Reconstr Surg. 2003;111:695–703.PubMedCrossRef
12.
13.
14.
Southern DA, Quan H, Ghali WA. Comparison of the Elixhauser and Charlson/Deyo methods of comorbidity measurement in administrative data. Med Care. 2004;42:355–60.PubMedCrossRef
15.
Clegg LX, Li FP, Hankey BF, Chu K, Edwards BK. Cancer survival among U.S. whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program population-based study. Arch Intern Med. 2002;162:1985–93.PubMedCrossRef
16.
Eley JW, Hill HA, Chen VW, et al. Racial differences in survival from breast cancer: results of the National Cancer Institute Black/White Cancer Survival Study. JAMA. 1994;272:947–54.PubMedCrossRef
17.
Ragland KE, Selvin S, Merrill DW. Black–white differences in stage-specific cancer survival: analysis of seven selected sites. Am J Epidemiol. 1991;133:672–82.PubMed
18.
Bassett MT, Krieger N. Social class and black–white differences in breast cancer survival. Am J Public Health. 1986;76:1400–3.PubMedCrossRef
19.
Dayal HH, Power RN, Chiu C. Race and socio-economic status in survival from breast cancer. J Chronic Dis. 1982;35:675–83.PubMedCrossRef
20.
21.
Finlayson CA, MacDermott TA, Arya J. Can specific preoperative counseling increase the likelihood a woman will choose postmastectomy breast reconstruction? Am J Surg. 2001;182:649–53.PubMedCrossRef
22.
Katipamula R, Degnim AC, Hoskin T, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27:4082–8.PubMedCrossRef
23.
McGuire KP, Santillan AA, Kaur P, et al. Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol. 2009;16:2682–90.PubMedCrossRef
24.
Bagley FH. The role of magnetic resonance imaging mammography in the surgical management of the index breast cancer. Arch Surg. 2004;139:380–3.PubMedCrossRef
25.
Bilimoria KY, Cambic A, Hansen NM, Bethke KP. Evaluating the impact of preoperative breast magnetic resonance imaging on the surgical management of newly diagnosed breast cancers. Arch Surg. 2007;142:441–7.PubMedCrossRef
26.
Chan A, Pintilie M, Vallis K, Girourd C, Goss P. Breast cancer in women < or =35 years: review of 1002 cases from a single institution. Ann Oncol. 2000;11:1255–62.PubMedCrossRef
27.
Champaneria MC, Wong WW, Hill ME, Gupta SC. The evolution of breast reconstruction: a historical perspective. World J Surg. 2012;36:730–42.PubMedCrossRef
28.
Fancher TT, Palesty JA, Thomas R, et al. A woman’s influence to choose mastectomy as treatment for breast cancer. J Surg Res. 2009;153:128–31.PubMedCrossRef
29.
Bian J, Krontiras H, Allison J. Outpatient mastectomy and breast reconstructive surgery. Ann Surg Oncol. 2008;15:1032–9.PubMedCrossRef
30.
Guyomard V, Leinster S, Wilkinson M. Systematic review of studies of patients’ satisfaction with breast reconstruction after mastectomy. Breast. 2007;16:547–67.PubMedCrossRef
31.
Malmgren JA, Parikh J, Atwood MK, Kaplan HG. Impact of mammography detection on the course of breast cancer in women aged 40–49 years. Radiology. 2012;262:797–806.PubMedCrossRef
32.
Selber JC, Kurichi JE, Vega SJ, Sonnad SS, Serletti JM. Risk factors and complications in free TRAM flap breast reconstruction. Ann Plast Surg. 2006;56:492–7.PubMedCrossRef
33.
Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL. Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg. 2006;118:1100–1.PubMedCrossRef
Metadata
Title
Racial Disparities in Immediate Breast Reconstruction After Mastectomy: Impact of State and Federal Health Policy Changes
Authors
Rachel L. Yang, BA
Andrew S. Newman, MD
Caroline E. Reinke, MD, MSPH
Ines C. Lin, MD
Giorgos C. Karakousis, MD
Brian J. Czerniecki, MD, PhD
Liza C. Wu, MD
Rachel R. Kelz, MD, MSCE
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2607-9

Other articles of this Issue 2/2013

Annals of Surgical Oncology 2/2013 Go to the issue

Colorectal Cancer

Ovarian Metastasis Is Associated with Retroperitoneal Lymph Node Relapses in Women Treated for Colorectal Peritoneal Carcinomatosis

Gynecologic Oncology

The Sentinel Node Technique Detects Unexpected Drainage Pathways and Allows Nodal Ultrastaging in Early Cervical Cancer: Insights from the Multicenter Prospective SENTICOL Study

Breast Oncology

Etiology of Breast Masses after Autologous Breast Reconstruction

Endocrine Tumors

A Comparison of Surgical Morbidity and Scar Appearance Between Gasless, Transaxillary Endoscopic Thyroidectomy (GTET) and Minimally Invasive Video-Assisted Thyroidectomy (VAT)

Hepatobiliary Tumors

Detection of Recurrences During Follow-up After Liver Surgery for Colorectal Metastases: Both Carcinoembryonic Antigen (CEA) and Imaging are Important

Endocrine Tumors

What Is the Best Definitive Treatment for Graves’ Disease? A Systematic Review of the Existing Literature