Abstract A039: Factors associated with reconstruction rates in breast cancer patients after mastectomy: Investigating disparities at a private versus safety net hospital

Abstract

Abstract Purpose: Despite post-mastectomy reconstruction being associated with improved body image, self-confidence, and quality of life, some evidence suggests that race, income, and insurance are associated with decreased rates of reconstruction. The purpose of this study was to evaluate the rates and factors associated with reconstruction after mastectomy at our institution’s private hospital (PH) and government safety net hospital (SNH). Methods: This retrospective study included 158 women (95 PH, 63 SNH) with unilateral, invasive, node-positive breast cancer who underwent surgery (mastectomy), chemotherapy, and radiotherapy in 2008–2019. We recorded age, race, preferred language, hospital, type of insurance, tumor features, and cancer treatment. Results: The median patient age was 52 (range, 27–83) years. Of the 158 patients, 60 underwent reconstruction: 52 (54.7%) at PH and 8 (12.7%) at SNH. Chi-squared tests identified age, race, language, insurance, and hospital as factors associated with reconstruction. In univariable regression analysis, these factors were associated with a higher odds of reconstruction: PPO insurance (OR 2.71, 95% CI 1.15–6.35) and treatment at PH (OR 10.48, 95% CI 4.71–23.32). Lower odds of reconstruction were associated with older age (age > 52 years: OR 0.47, 95% CI 0.25–0.87), Hispanic ethnicity (OR 0.22, 95% CI 0.10–0.50), Spanish as preferred language (OR 0.27, 95% CI 0.13–0.56), Medi-Cal HMO (OR 0.07, 95% CI 0.01–0.60), and being uninsured (OR 0.27, 95% CI 0.08–0.92). In multivariable analysis, only age remained significant: the odds of reconstruction were decreased in patients older than 52 years (OR 0.38, 95% CI 0.17–0.87). Conclusion: In women with unilateral, invasive, node-positive breast cancer, reconstruction after mastectomy was more frequent at our institution’s PH than at our SNH. Age, race, language, insurance, and hospital were associated with reconstruction after breast cancer resection in univariable analysis, but only age remained significantly associated with reconstruction in multivariable analysis. These results suggest that while demographic or socioeconomic factors may limit access to reconstruction after mastectomy, these factors are not as important as patient age. Citation Format: Thomas Norman, Lindsay Hwang, Jason Ye. Factors associated with reconstruction rates in breast cancer patients after mastectomy: Investigating disparities at a private versus safety net hospital [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A039.