African-American women with breast cancer are significantly more likely to undergo autologous or “flap” breast reconstruction (tissue from another place on their body is used to form the reconstructed breast) than implant-based reconstruction after a mastectomy, according to the results of a retrospective analysis.
The analysis, titled “Race and Breast Cancer Reconstruction: Is There a Health Care Disparity?” was published in the journal Plastic and Reconstructive Surgery.
Patients were twice as likely to receive autologous reconstruction even after researchers controlled for age, pathologic stage, and the type of health insurance as potential confounding factors.
Racial and ethnic disparities appear to be a continuing problem in the U.S. healthcare system, according to the study.
Specifically, researchers looked at whether different races and ethnicities share equal access to breast reconstruction after breast cancer treatment, and said it remains a challenging topic requiring additional investigation.
Because breasts are a symbol of femininity for many women, breast cancer can be a catastrophic diagnosis from both medical and psychosocial perspectives. The choice of breast reconstruction following oncology surgery (ranging from no reconstruction to implant-based to autologous tissue-based reconstruction) can be a highly personal affair.
“If the difference is related to system-based rather than patient-based factors, interventions may be needed to alleviate racial disparities in breast reconstruction,” Dr. Terence Myckatyn, MD, professor of plastic and reconstructive surgery and director of cosmetic and breast plastic surgery at Washington University in St. Louis, said in a press release.
Myckatyn and colleagues reviewed data from 2,533 women who underwent first-time autologous versus implant-based reconstruction following mastectomy between 2000 and 2013. Information regarding age, smoking, diabetes, obesity, provider, race, pathologic stage, health insurance type, charge to insurance, and socioeconomic status was recorded.
African-American women accounted for 14 percent of the cohort. The majority were non-Hispanic white (82 percent), and the remaining 4 percent belonged to other racial groups or were of unknown race. Sixty-seven percent, or 1,687 of the women in the study, underwent implant-based reconstructive surgery, and 18 percent (455 women) underwent autologous reconstruction. The reconstruction type was unknown for the remaining 15 percent (391 patients).
The results revealed that compared with whites, African-Americans were more likely to be underinsured, face a lesser charge for reconstruction, to smoke, to have diabetes, to suffer from obesity, to live in a zip code with a lower median household income, and to undergo autologous-based reconstruction.
On multivariate analysis, only African-American race, charge to insurance, and provider were independent predictors of the type of breast reconstruction, whereas age and diabetes were not.
“Our findings build on previous valuable work,” Myckatyn and his colleagues wrote. “Notable studies have found that African Americans are less likely to undergo immediate breast reconstruction, that this disparity persists despite Medicaid expansion, and that they are also less likely to undergo any type of breast reconstruction and less likely to consult with a plastic surgeon before oncologic resection.”
“The findings of this study should spur future research efforts that validate these results and identify potential causes,” the researchers wrote. “Ideally, large national registries can be augmented with specific patient surveys that confirm these findings and then posit which provider-based, patient-based, or systems-based variables are contributing to this particular healthcare disparity.”