P9 Ethnic variability in Post-Mastectomy Breast Reconstruction (PMBR)

Abstract

Background Current evidence for best practice indicates breast reconstruction post-mastectomy is associated with greater quality of life and psychological well-being.1 However, rates of reconstruction many not be equivalent across all ethnicities, which contributes to disparities in health outcomes.2 Methods A retrospective review of patients diagnosed with breast cancer between January 1st and December 31st, 2017 at Counties Manukau District Health Board (CMDHB) was performed. Patient demographics, eventual breast cancer treatment, and evidence of whether a reconstruction discussion took place were collected. This data was analysed to assess rates of reconstruction by ethnic group. Results 386 patients were diagnosed with cancer in CMDHB Breast cancer clinic in 2017. Of these women, 190 underwent mastectomy as primary treatment with 30 of these women also receiving reconstruction (either immediate or delayed) giving a reconstruction rate of 15.8%. Indigenous Maori women represented only 10% of the total immediate and delayed reconstructions in CMDHB in 2017. European women comprised 70% of total reconstructions but only represented 50% of all mastectomies. 34.7% of patients receiving mastectomy in 2017 were of Maori or Pasifika ethnicity. Of these patients, only 31.8% of women met eligibility criteria for immediate breast reconstruction at CMDHB (Body Mass Index (BMI) < 35 and non-smoker). There was a statistically significant difference between eligibility in Maori, Pasifika, European and Asian ethnicity groups for post-mastectomy reconstruction at BMI values below 35 (p < 0.05). Conclusion Eligibility rates for post-mastectomy reconstruction are significantly lower (p < 0.05) in Maori and Pasifika women when compared with European and Asian populations. This difference reflects higher smoking rates and higher BMI values in Maori and Pasifika women. Changing eligibility criteria such as having a higher BMI threshold for Maori and Pasifika women may improve access to breast reconstruction in these populations. 1. Cagli B, Cogliandro A, Barone M, Persichetti P. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg. 2014 Apr;133(4):594e–5e2. Schumacher JR, Taylor LJ, Tucholka JL, Poore S, Eggen A, Steiman J, et al. Socioeconomic Factors Associated with Post-Mastectomy Immediate Reconstruction in a Contemporary Cohort of Breast Cancer Survivors. Ann Surg Oncol. Springer International Publishing; 2017 Aug 1;24(10):3017–23.