Three national databases report highly varying rates of immediate breast reconstruction (IBR) among minority breast cancer patients undergoing breast removal for breast cancer, bringing focus to the already important issue of lower breast reconstruction rates among black and Hispanic women.
Since the databases are used to inform healthcare policy, it is crucial that lawmakers know and understand these variations, researchers pointed out.
Their study, “Differences in the reporting of racial and socioeconomic disparities among three large national databases for breast reconstruction,”appeared in the journal Plastic and Reconstructive Surgery.
The analyses included data from the Agency for Healthcare Research & Quality’s Nationwide Inpatient Sample (NIS) database, the American College of Surgeons’ National Surgical Quality Improvement Project (NSQIP) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program.
Researchers analyzed information from about 1.2 million patients between 2005 and 2012. During this time, overall IBR rates had gone up. The NIS database reported a rise from 19 percent to 47 percent, NSQIP from 30 percent to 49 percent, and SEER from 12 percent to 25 percent of invasive breast cancer cases.
While all three databases showed that white women were most likely to get the reconstructive surgery, the rates differed. The NIS reported rates of 35.7 percent among white women with invasive breast cancer, followed by black women (27.3%), Hispanic women (30.8%) and Asian women (30.5%).
While NSQIP reported similar percentages — 43.1%, 30.7%, 40.3% and 32.1%, respectively — data from the SEER showed sharply lower rates: 20.6% in white women, 15.5% in African-American women, 12.9% in Hispanic women and 14.0% in Asian women.
These differences may be related to coverage of the databases. The NIS and NSQIP record practice in most U.S. states, while the SEER covers fewer than half the 50 states, and no major U.S. cancer centers.
“Since these large databases play an important role in making healthcare policy, it’s important to appreciate the significant differences in racial and socioeconomic disparities in immediate breast reconstruction,” senior author Samuel J. Lin, MD, MBA, of Harvard Medical School, and a member of the American Society of Plastic Surgeons, said in a press release. “One database should not uniformly be utilized for clinical guidelines and policies.”