Socio-demographic, clinical, and health-related factors associated with breast reconstruction – A nationwide cohort study

Abstract

Keywords:Breast reconstruction Breast cancer Surgery Mastectomy Information given Socio-demographic factors a b s t r a c tWe collected registry-and questionnaire-based data on socio-economic and health status, tumor-and treatment-related variables, and explored associations with receipt of reconstruction and information about treatment options in a nationwide cohort of Danish women, treated for primary breast cancer.A total of 594 women were available for analysis, 240 (40%) of these received reconstruction.Multivariate analyses showed that receipt of reconstruction was associated with 1) younger age at time of primary surgery (<36 years: OR ¼ 10.04, [3.80e26.50], p < 0.001 and 36e49 years: OR ¼ 2.48, [1.73e3.56], p < 0.001, compared to 50e60 year olds), 2) having received radiotherapy (OR ¼ 0.57, [0.40 e0.81], p ¼ 0.002), 3) high income (Second quartile: OR ¼ 1.74, [1.05e2.90], p ¼ 0.033 and fourth quartile: OR ¼ 2.18, [1.31e3.62], p ¼ 0.003, compared with the lowest income quartile), and 4) ethnicity other than Danish (OR ¼ 6.32, [1.58e25.36], p ¼ 0.009).Health-related factors at the time of primary surgery (physical functioning, body mass index, smoking, use of alcohol, and comorbidity) were not associated with reconstruction. Odds of having received information about the option of reconstruction decreased by 8% per year of age in the multivariate analysis (OR ¼ 0.92, [0.87e0.97], p ¼ 0.003).In conclusion, younger age and not having been treated with radiotherapy was independently associated with reconstruction. In addition, higher income was also found to be associated with reconstruction despite free and equal access to reconstruction and healthcare in Denmark. Healthrelated factors were not associated with the use of reconstruction following mastectomy. Our findings underscore the need for physicians to ensure optimal level of information and accessibility to reconstruction for all women regardless of age, treatment, and socio-economic status.

Understanding the effects of socioeconomic status along the breast cancer continuum in Australian women: a systematic review of evidence

“…Australian treatment choice results were similar to international findings, with women living in deprived areas having reduced odds of surgery and radiotherapy [ 86 ], breast reconstruction surgery [ 88 , 89 ] and higher rates of non-conservative surgery [ 90 ] and mastectomies [ 86 ]. Fig.…”

Income, costs, and health care utilization may influence surgical choice in early stage breast cancer

“…There are many other studies that seek to define socio‐economic variable that affects surgical choice and disease‐related outcomes Our findings on income are in line with other studies that show lower income is associated with lower rates of reconstruction. In particular, the 2015 study by Bodilsen demonstrated that higher income was associated with higher rates of reconstruction among Danish women with free and equal access to health care.…”

Association of sociodemographic and oncological features with decision on implant‐based versus autologous immediate postmastectomy breast reconstruction in Chinese patients

“…The results of univariate analysis indicate that unmarried patients younger than 40 years with BMI ≤ 24 kg/m 2 , early‐stage noninvasive lesions, and bilateral nipple/skin‐sparing mastectomies and without neoadjuvant chemotherapy are more likely to opt for implant‐based than autologous IPBR. Surprisingly, the economic status and residency display little influence on the decision, despite they significantly affect the receipt of breast reconstruction . The family history of breast or ovarian cancer, an independent predictor of contralateral prophylactic mastectomy, also demonstrates nonsignificant association with the decision on type of IPBR.…”