Introduction:
Significant disparities in immediate breast reconstruction after mastectomy have persisted, and may even be increasing, despite large-scale efforts to minimize them, such as the Women’s Health and Cancer Rights Act of 1998. Immediate breast reconstruction has been shown to lead to higher rates of surgical satisfaction, minimize delay in post-operative cancer treatment, and improve the quality of life and overall well-being of mastectomy patients. However only 25-40% of eligible women in the United States receive reconstruction. The rate of reconstruction is even lower in African American and Hispanic women compared to White women. To better understand this disparity, this study uses national population-based data to examine how demographic factors, socioeconomic factors, and disease characteristics interact and affect the rate of immediate breast reconstruction (IBR) after mastectomy.
Methods:
Women with AJCC7 Stage 0-III breast cancer who underwent mastectomy from 2010 to 2012 were identified in the Surveillance, Epidemiology and End Results Program (SEER) database. Race, Hispanic ethnicity, age, marital status, insurance status, tumor grade, AJCC7 stage and hormone receptor/ Her2Neu profile were compared between women undergoing mastectomy with IBR and mastectomy alone using univariate and multivariate analysis.
Results:
We identified 51,115 women who underwent mastectomy for Stage 0-III breast cancer from 2010-2012, of whom 15,389 (30.1%) received IBR. On multivariate analysis, age (p
Conclusion:
The decision to undergo reconstruction after mastectomy is influenced by many factors. Our results show that even after adjusting for tumor characteristics, socioeconomic factors are independently associated with receiving IBR after mastectomy. Further research is needed to elucidate the factors that influence the decision to undergo IBR in order to eliminate these persistent disparities
