Reconstruction among patients undergoing mastectomy: the effect of surgical deserts

Vora, Halley; Chung, Alice; Lewis, Azaria V.; Mirocha, Jim; Amersi, Farin; Giuliano, Armando E.; Alban, Rodrigo F.

doi:10.1016/j.jss.2017.11.011

Cited by 10 publications

(3 citation statements)

References 27 publications

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“…5 Hospital and system-level considerations, such as geographic access to academic centers offering reconstruction, type of hospital, and density of plastic surgeons, have also been found to contribute to differences in reconstruction rates. 22,24,25 Finally, provider-level considerations, including initial referral to a plastic surgeon and discussions about reconstruction from both surgical oncologists and plastic surgeons, have been found to vary by race, ethnicity, and insurance status, 7,20,26 and could contribute to our reported lower rates of reconstruction among minorities and the uninsured.…”

Section: Discussionmentioning

confidence: 86%

Decline in Racial Disparities in Postmastectomy Breast Reconstruction: A Surveillance, Epidemiology, and End Results Analysis from 1998 to 2014

Sergesketter

Thomas

Lane

et al. 2019

Plastic &Amp; Reconstructive Surgery

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Background: Despite increasing emphasis on reducing racial disparities in breast cancer care in the United States, it remains unknown whether access to breast reconstruction has improved over time. The authors characterized contemporary patterns of breast reconstruction by race and ethnicity. Methods: The Surveillance, Epidemiology, and End Results database was used to identify women undergoing mastectomy for stage 0 to III breast cancer from 1998 to 2014. Multivariable logistic regression was used to estimate the association of demographic factors with likelihood of postmastectomy reconstruction. Multivariable logistic regression was used to predict reconstruction subtype. Patients undergoing reconstruction were grouped by diagnosis year to assess change in the population over time by race and ethnicity. Results: Of 346,418 patients, 21.8 percent underwent immediate reconstruction. Non-Hispanic black race (OR, 0.71) and Hispanic ethnicity (OR, 0.63) were associated with a decreased likelihood of reconstruction (all p < 0.001). Race was predictive of reconstruction type, with non-Hispanic black (OR, 1.52) and Hispanic women (OR, 1.22) more likely to undergo autologous versus implant-based reconstruction (p < 0.001). Although rates of reconstruction increased over time across all races, non-Hispanic black and Hispanic patients had a higher adjusted per-year increase in rate of reconstruction compared with non-Hispanic white patients (interaction p < 0.001). Conclusions: Rates of postmastectomy reconstruction have increased more quickly over time for minority women compared with white women, suggesting that racial disparities in breast reconstruction may be improving. However, race continues to be associated with differences in

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Section: Discussionmentioning

confidence: 86%

Decline in Racial Disparities in Postmastectomy Breast Reconstruction: A Surveillance, Epidemiology, and End Results Analysis from 1998 to 2014

Sergesketter

Thomas

Lane

et al. 2019

Plastic &Amp; Reconstructive Surgery

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“…35 AI/AN women have been shown to have longer lengths of stay and half the likelihood of outpatient breast surgery. 47,48 Other studies have shown lower rates of breast reconstruction for racial minorities, 20,44,49 but information on postmastectomy reconstruction was not available for the present study.…”

Section: Surgical Disparitiesmentioning

confidence: 84%

“…Research has shown rurality affects reconstruction as patients from surgical deserts are significantly less likely to receive reconstruction. 49 The lower reconstruction rates for rural women and minorities suggest that AI/AN women are similarly vulnerable.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Breast-Conserving Therapy for Non-Hispanic American Indian/Alaska Native Women Compared with Non-Hispanic White Women

et al. 2021

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Background Little is known about the surgical patterns of American Indian/Alaska Native (AI/AN) breast cancer patients. The purpose of this study is to determine whether there are disparities in breast cancer surgery and radiation therapy between non-Hispanic AI/AN (NH-AI/AN) women and non-Hispanic White (NHW) women. Methods Data from the National Program of Cancer Registries of the Centers for Disease Control and Surveillance, Epidemiology, and End Results were used for this cross-sectional study. Female patients with invasive breast cancer diagnosed 2010–2015 were stratified by race/ethnicity, surgical procedure, radiation, and region. Percentage distributions of mastectomy and lumpectomy were compared overall and by region and stage. Results From 2010 to 2015 there were 3292 NH-AI/AN women and 165,225 NHW women diagnosed with breast cancer. For early stage (AJCC stage 1 and 2), NH-AI/AN women had overall significantly higher percentage of mastectomy (41% vs 34.4%, p < 0.001) and significantly lower percentage of lumpectomy (59% vs 65.6%) compared with NHW women, without significant differences in post-lumpectomy radiation (71% vs 70%). There were regional variations, notably in the Northern Plains, where the percentage of mastectomy for early-stage disease was 48.9% for NH-AI/AN women versus 35.9% for NHW women, and in Alaska with 47% for NH-AI/AN women versus 33.3% for NHW women (p < 0.001). There were no overall significant differences in type of surgery or radiation for late-stage disease between groups. Conclusion This is the first study to show disparities in surgical management of NH-AI/AN women with breast cancer. For early-stage disease, NH-AI/AN women undergo a higher percentage of mastectomy. Future clinical directions could focus on the factors that drive awareness, decision-making, and access to breast conservation.

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Geographic Variation in Medical Neighborhoods for Breast Cancer Care: Diagnosis and Beyond

Tsui

Doose

Henry

2019

Energy Balance and Cancer

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Reconstruction among patients undergoing mastectomy: the effect of surgical deserts

Cited by 10 publications

References 27 publications

Decline in Racial Disparities in Postmastectomy Breast Reconstruction: A Surveillance, Epidemiology, and End Results Analysis from 1998 to 2014

Decline in Racial Disparities in Postmastectomy Breast Reconstruction: A Surveillance, Epidemiology, and End Results Analysis from 1998 to 2014

Disparities in Breast-Conserving Therapy for Non-Hispanic American Indian/Alaska Native Women Compared with Non-Hispanic White Women

Geographic Variation in Medical Neighborhoods for Breast Cancer Care: Diagnosis and Beyond

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