Evaluating Disparities in Pathways to Breast Reconstruction

被引:7
作者
Wang, Sabrina M. M. [1 ]
Njoroge, Moreen W. W. [1 ]
Mundy, Lily R. R. [2 ,3 ]
Sergesketter, Amanda R. R. [4 ]
Stukes, Bryanna [1 ]
Shammas, Ronnie L. L. [4 ]
Langdell, Hannah C. C. [4 ]
Geng, Yisong [5 ]
Hollenbeck, Scott T. T. [4 ,6 ]
机构
[1] Duke Univ, Sch Med, Durham, NC 27710 USA
[2] Univ Maryland, R Adams Cowley Shock Trauma Ctr, Dept Orthopaed Surg, Baltimore, MD USA
[3] Johns Hopkins Univ, Dept Plast & Reconstruct Surg, Baltimore, MD USA
[4] Duke Univ, Div Plast Oral & Maxillofacial Surg, Durham, NC 27710 USA
[5] Calc LLC, Wilton, CT USA
[6] Duke Univ, Div Plast & Reconstruct Surg, Med Ctr, Box 3945, Durham, NC 27710 USA
关键词
breast reconstruction; disparities; breast cancer; RACIAL DISPARITIES; MASTECTOMY; HEALTH; OUTCOMES; COMMUNICATION; IMMEDIATE; SURGEON; OBESITY; TRENDS; IMPACT;
D O I
10.1055/s-0043-1764486
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Rates of postmastectomy breast reconstruction have been shown to vary by racial, ethnic, and socioeconomic factors. In this study, we evaluated disparities across pathways toward breast reconstruction.Methods All women who underwent mastectomy for breast cancer at a single institution from 2017 to 2018 were reviewed. Rates of discussions about reconstruction with breast surgeons, plastic surgery referrals, plastic surgery consultations, and ultimate decisions to pursue reconstruction were compared by race/ethnicity.Results A total of 218 patients were included, with the racial/ethnic demographic of 56% white, 28% Black, 1% American Indian/Native Alaskan, 4% Asian, and 4% Hispanic/Latina. The overall incidence of postmastectomy breast reconstruction was 48%, which varied by race (white: 58% vs. Black: 34%; p < 0.001). Plastic surgery was discussed by the breast surgeon with 68% of patients, and referrals were made in 62% of patients. While older age ( p < 0.001) and nonprivate insurance ( p < 0.05) were associated with lower rates of plastic surgery discussion and referral, it did not vary by race/ethnicity. The need for an interpreter was associated with lower rates of discussion ( p < 0.05). After multivariate adjustment, a lower reconstruction rate was associated with the Black race (odds ratio [OR] = 0.33; p = 0.014) and body mass index (BMI) = 35 (OR = 0.14; p < 0.001). Elevated BMI did not disproportionately lower breast reconstruction rates in Black versus white women ( p = 0.27).Conclusion Despite statistically equivalent rates of plastic surgery discussions and referrals, black women had lower breast reconstruction rates versus white women. Lower rates of breast reconstruction in Black women likely represent an amalgamation of barriers to care; further exploration within our community is warranted to better understand the racial disparity observed.
引用
收藏
页码:671 / 680
页数:10
相关论文
共 42 条
[1]   Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer [J].
Agarwal, Shailesh ;
Pappas, Lisa ;
Neumayer, Leigh ;
Kokeny, Kristine ;
Agarwal, Jayant .
JAMA SURGERY, 2014, 149 (03) :267-274
[2]   Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction [J].
Al-Ghazal, SK ;
Fallowfield, L ;
Blamey, RW .
EUROPEAN JOURNAL OF CANCER, 2000, 36 (15) :1938-1943
[3]   The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors [J].
Alderman, AK ;
McMahon, L ;
Wilkins, EG .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2003, 111 (02) :695-703
[4]   Correlates of referral practices of general surgeons to plastic surgeons for mastectomy reconstruction [J].
Alderman, Amy K. ;
Hawley, Sarah T. ;
Waljee, Jennifer ;
Morrow, Monica ;
Katz, Steven J. .
CANCER, 2007, 109 (09) :1715-1720
[5]   Racial and Ethnic Disparities in the Use of Postmastectomy Breast Reconstruction: Results From a Population-Based Study [J].
Alderman, Amy K. ;
Hawley, Sarah T. ;
Janz, Nancy K. ;
Mujahid, Mahasin S. ;
Morrow, Monica ;
Hamilton, Ann S. ;
Graff, John J. ;
Katz, Steven J. .
JOURNAL OF CLINICAL ONCOLOGY, 2009, 27 (32) :5325-5330
[6]  
[Anonymous], TEXT S1192 114 C 201
[7]  
[Anonymous], Breast Cancer Statistics | How Common Is Breast Cancer? Accessed June 22, 2022
[8]   Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP [J].
Blankensteijn, Louise L. ;
Sparenberg, Sebastian ;
Crystal, Dustin T. ;
Ibrahim, Ahmed M. S. ;
Lee, Bernard T. ;
Lin, Samuel J. .
JOURNAL OF RECONSTRUCTIVE MICROSURGERY, 2020, 36 (08) :592-599
[9]   The BREAST-Q in surgical research: A review of the literature 2009-2015 [J].
Cohen, Wess A. ;
Mundy, Lily R. ;
Ballard, Tiffany N. S. ;
Klassen, Anne ;
Cano, Stefan J. ;
Browne, John ;
Pusic, Andrea L. .
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, 2016, 69 (02) :149-162
[10]   Racial Disparities in Breast Reconstruction at a Comprehensive Cancer Center [J].
Connors, Shahnjayla K. ;
Goodman, Melody S. ;
Myckatyn, Terence ;
Margenthaler, Julie ;
Gehlert, Sarah .
JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES, 2022, 9 (06) :2323-2333