Disparities In Breast Reconstruction Research Articles

Disparities in Breast Reconstruction: An Analysis of Treatment Choices.

Breast reconstruction methods vary based on factors such as medical history, breast size, and personal preferences. However, disparities in healthcare exist, and the role race plays in accessing to different reconstruction methods is unclear. This study aimed to investigate the influence of race and/or ethnicity on the type of breast reconstruction chosen. This retrospective cohort study analyzed the University of Pittsburgh Medical Center Magee Women's Hospital database, including patients who underwent breast cancer surgery from 2011 to 2022. Multivariate analysis examined race, reconstruction, and reconstruction type (P < 0.05). The database included 13,260 women with breast cancer; of whom 1763 underwent breast reconstruction. We found that 91.8% of patients were White, 6.8% Black, and 1.24% were of other races (Asian, Chinese, Filipino, Vietnamese, unknown). Reconstruction types were 46.8% implant, 30.1% autologous, and 18.7% combined. Among Black patients, autologous 36.3%, implant 32.2%, and combined 26.4%. In White patients, autologous 29.5%, implant 48%, and combined 18.2%. Among other races, autologous 36.3%, implant 40.9%, and combined 22.7%. In patients who underwent breast reconstruction, 85.2% underwent unilateral and 14.7% of patients underwent bilateral. Among the patients who had bilateral reconstruction, 92.3% were White, 6.1% were Black, and 1.5% were of other ethnicities. Our analysis revealed differences in breast reconstruction methods. Autologous reconstruction was more common among Black patients, and implant-based reconstruction was more common among Whites and other races. Further research is needed to understand the cause of these variations.

Charting Outcomes: The Correlation Between Area of Deprivation Index and Disparities in Breast Reconstruction

Charting Outcomes: The Correlation Between Area of Deprivation Index and Disparities in Breast Reconstruction

Current Trends in Autologous Breast Reconstruction and the Implications of Impending Changes to Insurance Reimbursement.

Introduction In 2019, the Centers for Medicare & Medicaid Services (CMS) combined all autologous breast flap procedures under one billing code, effective from December 31, 2024. This change will result in equal insurance reimbursement rates for popular flap options, such as transverse rectus abdominis muscle (TRAM) and deep inferior epigastric perforator (DIEP) flaps, which were previously billed separately using S-codes based on complexity. Methods This study aimed to analyze insurance code changes for autologous breast reconstruction flap procedures. Data were collected from the American Society of Plastic Surgeons' annual plastic surgery statistics reports, including specific insurance codes and case volumes from 2007 to 2020. A comprehensive analysis was conducted to assess recent trends in flap utilization rates, documenting any modifications or additions to the existing codes and their implementation years. Results The study analyzed billing codes and case volumes for autologous breast reconstruction procedures, with a focus on the DIEP flap and other alternatives. Non-autologous breast reconstruction procedures showed consistently higher case volumes compared to autologous procedures from 2007 to 2020. Notably, the popularity of the DIEP flap surpassed that of other flap options after 2011. Conclusion The removal of S-codes for autologous breast reconstruction by CMS and the subsequent potential decrease in insurance coverage for the DIEP flap may lead to a decrease in its utilization and a shift towardmore invasive options, like the TRAM flap. This change could result in financial burdens for patients and widen socioeconomic disparities in breast reconstruction, limiting access to preferred reconstructive methods and impacting patient autonomy and overall well-being.

Factors Associated With Socioeconomic Disparities in Breast Reconstruction: Perspectives of Wisconsin Surgeons

IntroductionThe objective is to expand our understanding of the factors associated with receipt of breast reconstruction for socioeconomically disadvantaged women within Wisconsin. MethodsA purposeful sample of general/breast and plastic surgeons were identified. One-on-one interviews were conducted, audio-recorded, and transcribed in full (n = 15). Conventional content analysis was performed to identify themes. ResultsBoth general/breast and plastic surgeons perceived that general/breast surgeons served as gatekeepers to which patients are offered a referral for reconstruction. Given the additional recovery time, frequent clinic visits, and potential for complications associated with reconstruction, general/breast surgeons perceived that not all women prioritize it. Surgeons perceived this to be especially true for socioeconomically disadvantaged women. Surgeons identified time off work, travel for visits, and out-of-pocket costs as specific challenges to reconstruction experienced by socioeconomically disadvantaged women. Surgeons perceived that early education, incorporating financial considerations into discussions, and reducing travel burden may help to improve access to reconstruction. ConclusionWisconsin surgeons described factors they perceived contributed to lower rates of reconstruction for socioeconomically disadvantaged women and described ways to increase reconstruction access.

Impact of Race, Ethnicity, Primary Language, and Insurance on Reconstruction after Mastectomy for Patients with Breast Cancer at an Urban, Academic Safety-Net Hospital.

Disparities in breast reconstruction have been observed in national cohorts and single-institution studies based on race, ethnicity, insurance, and language. However, little is known regarding whether safety-net hospitals deliver more or less equitable breast reconstruction care in comparison with national cohorts. We performed a retrospective study of patients with either invasive breast cancer or ductal carcinoma in situ diagnosed and treated at our institution (January 1, 2009, to December 31, 2014). The rate of, timing of, and approach to breast reconstruction were assessed by race, ethnicity, insurance status, and primary language among women who underwent mastectomy. Reasons for not performing reconstruction were also analyzed. A total of 756 women with ductal carcinoma in situ or nonmetastatic invasive cancer were identified. The median age was 58.5 years, 56.2% were non-White, 33.1% were non-English-speaking, and 48.9% were Medicaid/uninsured patients. A total of 142 (18.8%) underwent mastectomy during their index operation. A total of 47.9% (n = 68) did not complete reconstruction. Reasons for not performing reconstruction included patient preference (n = 22), contraindication to immediate reconstruction (ie, locoregionally advanced disease prohibiting immediate reconstruction) without follow-up for consideration of delayed reconstruction (n = 12), prohibitive medical risk or contraindication (ie, morbid obesity; n = 8), and progression of disease, prohibiting reconstruction (n = 7). Immediate and delayed reconstruction were completed in 43.7% and 8.5% of patients. The rate of reconstruction was inversely associated with tumor stage (odds ratio 0.52, 95% CI 0.31 to 0.88), but not race, ethnicity, insurance, or language, on multivariate regression. At a safety-net hospital, we observed rates of reconstruction at or greater than national estimates. After adjustment for clinical attributes, rates did not vary by race, ethnicity, insurance or language. Future research is needed to understand the role of reconstruction in breast cancer care and how to advance shared decision-making among diverse patients.

Community collaboration to improve access and outcomes in breast cancer reconstruction: protocol for a mixed-methods qualitative research study

IntroductionBreast reconstruction plays an important role for many in restoring form and function of the breast after mastectomy. However, rates of breast reconstruction in the USA vary significantly by race,...

National Disparities in Autologous Breast Reconstruction

PURPOSE: Autologous breast reconstruction has evolved from more morbid procedures that sacrificed the patient’s abdominal muscle (the TRAM or transverse rectus abdominus muscle flap) to more elegant autologous reconstructions termed “perforator” flaps that spare fascia and muscle to harvest only the adipose tissue. Commercial insurers have recognized the higher technical demand for perforator flaps relative to other autologous reconstructions by creating separate procedural codes with significantly higher professional fees. This study examined whether a perforator flap procedure code unavailable with Federally issued Medicare or Medicaid disproportionally incentivizes perforator flaps among the commercially insured and, subsequently, patients from a higher socioeconomic status. METHODS: Autologous reconstructions performed between 2008 and 2014 were reviewed from the National Inpatient Sample using the ICD-9-CM procedure codes 85.72, 85.73, 85.74, 85.75, and 85.76. Extracted variables included age, race, comorbidities, hospital type, hospital region, insurance payer type, and median household income quartile. Autologous breast reconstruction was subdivided into microvascular perforator flaps (85.74, 85.75, 85.76), microvascular TRAM flaps (85.73), and pedicled TRAM flaps (85.72). Demographics, comorbidities, and access to care were compared between cohorts by chi-squared and ANOVA tests. A logistic regression comparing microvascular reconstructions only was created to predict the effects of insurance, geography, income quartile, and race on the likelihood of perforator flap reconstruction while controlling for age and comorbidities. RESULTS: After querying and weighting National Inpatient Sample data, 33,246 microvascular perforator flap breast reconstructions, 16,804 microvascular TRAM flap reconstructions, and 16,918 pedicled TRAM flap reconstructions were compared. The majority of patients undergoing autologous reconstruction were Whites (64.1%), with a mean age of 51.1 years. Patients receiving microvascular perforator flaps had fewer total comorbidities than patients receiving microvascular TRAM (P < 0.001) or pedicled TRAM (P = 0.003) flaps. Perforator flaps were significantly more likely among the commercially insured (perforator flap: 85.8% versus microvascular TRAM: 75.9% versus pedicled TRAM: 75.0%, P < 0.001), while TRAM flaps were more likely among patients with Medicare or Medicaid (perforator flap: 14.2% versus microvascular TRAM: 24.1% versus pedicled TRAM: 25.0%, P < 0.001). Patients of higher income quartiles were significantly more likely to receive perforator flap autologous reconstruction (P < 0.001). When comparing microvascular reconstruction, logistic regression revealed an odds ratio of 1.72 (P < 0.001) for perforator flaps among the commercially insured when compared with patients with Medicare or Medicaid. Income trends paralleled insurance status. When compared with the lowest income quartile, the second quartile had an odds ratio of 1.11 (P = 0.003) for perforator flap reconstruction, the third 1.07 (P = 0.029), and the fourth 1.36 (P < 0.001). Compared with rural locations, urban nonteaching hospitals had an odds ratio of 2.42 (P < 0.001) for perforator flap reconstruction and urban teaching hospitals had an odds ratio of 4.08 (P < 0.001). Asian patients had a higher odds ratio of receiving perforator flaps than White patients, with an odds ratio of 1.16 (P = 0.010). Black and Hispanic patients had comparable rates as White patients, with odds ratios of 0.97 and 0.95, respectively (P = 0.342, P = 0.192). CONCLUSIONS: Reimbursement incentives disproportionally favor perforator flap autologous reconstruction among the commercially insured. Differences across insurance status exaggerate already existing disparities in breast reconstruction across socioeconomic status.

Racial Disparities in Breast Reconstruction at a Comprehensive Cancer Center.

Breast reconstruction after a mastectomy is an important component of breast cancer care that improves the quality of life in breast cancer survivors. African American women are less likely to receive breast reconstruction than Caucasian women. The purpose of this study was to further investigate the reconstruction disparities we previously reported at a comprehensive cancer center by assessing breast reconstruction rates, patterns, and predictors by race. Data were obtained from women treated with definitive mastectomy between 2000 and 2012. Sociodemographic, tumor, and treatment characteristics were compared between African American and Caucasian women, and logistic regression was used to identify significant predictors of reconstruction by race. African American women had significantly larger proportions of public insurance, aggressive tumors, unilateral mastectomies, and modified radical mastectomies. African American women had a significantly lower reconstruction rate (35% vs. 49%, p < 0.01) and received a larger proportion of autologous reconstruction (13% vs. 7%, p < 0.01) compared to Caucasian women. The receipt of adjuvant radiation therapy was a significant predictor of breast reconstruction in Caucasian but not African American women. We identified breast reconstruction disparities in rate and type of reconstruction. These disparities may be due to racial differences in sociodemographic, tumor, and treatment characteristics. The predictors of breast reconstruction varied by race, suggesting that the mechanisms underlying breast reconstruction may vary in African American women. Future research should take a target approach to examine the relative contributions of sociodemographic, tumor, and treatment determinants of the breast reconstruction disparities in African American women.

Persistent Disparities in Postmastectomy Breast Reconstruction and Strategies for Mitigation.

For many women, breast reconstruction is an essential component of the breast cancer care continuum after mastectomy. Despite postmastectomy breast reconstruction now being a standard of care, numerous studies over the past decade have documented persistent racial disparities in breast reconstruction rates, physician referral patterns, and patient knowledge of their reconstructive options. These disparities have disproportionately impacted women of color-most specifically, African American women. Recent data have revealed racial differences in patient comorbidities, informed decision-making satisfaction, and clinical outcomes after breast reconstruction. Explicitly, African American women have significantly more risk factors for complications and less baseline knowledge regarding reconstructive options than white women. With a recent heightened attention focused on social determinants of health, studies designed to improve these racial differences have demonstrated promising results through educational outreach to underserved communities, implementation of tailored legislation promoting inclusion, diversity, and equity, and encouragement of additional recruitment of ethnically underrepresented-in-medicine surgeons. This study uses a targeted review of the literature to provide a summary of racial disparities in breast reconstruction for African American women, with our perspective on opportunities for improvement.

Abstract B018: Exploring racial disparities in breast reconstruction after mastectomy at an NCI-Designated Cancer Center

Abstract Introduction: Breast reconstruction after mastectomy is an important component of comprehensive breast cancer care due to its positive effects on quality of life for breast cancer survivors. Yet, African American women are significantly less likely to receive breast reconstruction compared to Caucasian women. Due to the positive impact breast reconstruction has on quality of life in breast cancer patients, these disparities have implications for survivorship in African American women who already bear the excess burden of breast cancer mortality. We previously reported the presence of breast reconstruction disparities at Siteman Cancer Center, a large, urban National Cancer Institute-designated Comprehensive Cancer Center located in St. Louis, Missouri. The purpose of this study was to further understand these disparities by assessing breast reconstruction rates, patterns, and predictors by race. Methods: Sociodemographic, clinical, and treatment data were obtained for women who received mastectomy for definitive surgical treatment for breast cancer from 2000 to 2012. Statistical tests were used to compare the data between African American and Caucasian women. Logistic regression was used to identify significant predictors of breast reconstruction stratified by race. Results: African American women had significantly higher proportions of public insurance, more aggressive tumors, unilateral mastectomies, and modified radical mastectomies. These are characteristics that reduce the odds of receiving breast reconstruction. African American women had a significantly lower breast reconstruction rate and higher proportion of autologous-based breast reconstruction, which has higher complication rates than implant-based breast reconstruction. Adjuvant radiation was a significant predictor in Caucasian, but not in African American women. Conclusion: African American and Caucasian women varied in rate and type of breast reconstruction. These disparities may be due to racial differences in sociodemographic, clinical, and treatment factors. Additionally, since the predictors of breast reconstruction varied by race, the underlying mechanisms for the receipt of breast reconstruction may vary in African American women. Future research should focus on further examining the determinants of the breast reconstruction, by modality, and the role breast reconstruction disparities play in clinical outcomes and quality of life in African American women. Citation Format: Shahnjayla K. Connors, Melody G. Goodman, Terence Myckatyn, Julie Margenthaler, Sarah Gehlert. Exploring racial disparities in breast reconstruction after mastectomy at an NCI-Designated Cancer Center [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B018.

Abstract A126: Rural-urban differences in breast reconstruction utilization following mastectomy

Abstract Background: Healthcare disparities in rural women are well-defined, however little is known about breast reconstruction (BR) utilization in this population, especially rural Kentucky. The goal of this study was to determine if disparities in BR exist among post-mastectomy rural female patients in Kentucky. Methods: The Kentucky Cancer Registry was used to identify patients diagnosed with breast cancer and treated with mastectomy from 2006-2015. Patients were subdivided into mastectomy-only and mastectomy plus BR groups. 2013 Beale codes were used to stratify patients according to urban, near-metro or rural status. Chi-square tests were used to examine the association of BR along the rural-urban continuum. A multivariate logistic regression model controlling for patient, disease and treatment factors was used to predict BR. The likelihood of undergoing BR was reported in odds ratios (OR) using a 95% confidence interval (CI). Results: Overall, 12,036 patients underwent mastectomy. Of these patients, 2,822 (23.4%) also underwent BR. The rate of BR among urban, near-metro and rural patients was 32.4%, 23.1% and 14.7%, respectively. Multivariate analysis revealed that women from near metro (OR 0.56, CI 0.50-0.63; p &amp;lt; 0.001) and rural areas (OR 0.38, CI 0.33-0.43; p &amp;lt;0.001) were less likely to undergo BR than women from urban areas. Conclusion: Although BR benefits are well documented, women from rural areas undergo BR at lower rates and are less likely to receive BR than their urban and near-metro counterparts. While multiple factors contribute to this disparity, future efforts should seek to improve comprehensive breast cancer care which includes access to a reconstructive breast surgeon. Citation Format: Robert-Marlo F. Bautista, Ryan C. DeCoster, Jack C. Burns, Robert W. Edmunds, Adam J. Dugan, Brian J. Rinker, Matthew Webster, Henry C. Vasconez. Rural-urban differences in breast reconstruction utilization following mastectomy [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A126.

Breast Reconstruction Disparities in the United States and Internationally

Women electing to undergo breast reconstruction following mastectomy have increased in frequency. Classically studied healthcare disparities have an influence on whether women undergo reconstruction. This review evaluates these domains, globally, while exploring why they exist. In the USA, women who are young, white, with higher income and education level, private insurance, and those treated at private or academic hospitals are most likely to undergo reconstruction. Women of a minority race or ethnicity, lower socioeconomic group, early education status, and with public or no insurance remain less likely to undergo reconstruction. Breast reconstruction is not commonly available to women in low- and middle-income countries. Disparities in breast reconstruction persist though significant strides have been made in many high-income nations. Internationally, concerted efforts are needed that focus on health literacy education, access to surgical consultations, and an inclusion of breast reconstruction in the breast cancer treatment process.

Breast reconstruction after mastectomy at a comprehensive cancer center.

BackgroundBreast reconstruction after mastectomy is an integral part of breast cancer treatment that positively impacts quality of life in breast cancer survivors. Although breast reconstruction rates have increased over time, African American women remain less likely to receive breast reconstruction compared to Caucasian women. National Cancer Institute-designated Comprehensive Cancer Centers, specialized institutions with more standardized models of cancer treatment, report higher breast reconstruction rates than primary healthcare facilities. Whether breast reconstruction disparities are reduced for women treated at comprehensive cancer centers is unclear. The purpose of this study was to further investigate breast reconstruction rates and determinants at a comprehensive cancer center in St. Louis, Missouri.MethodsSociodemographic and clinical data were obtained for women who received mastectomy for definitive surgical treatment for breast cancer between 2000 and 2012. Logistic regression was used to identify factors associated with the receipt of breast reconstruction.ResultsWe found a breast reconstruction rate of 54 % for the study sample. Women who were aged 55 and older, had public insurance, received unilateral mastectomy, and received adjuvant radiation therapy were significantly less likely to receive breast reconstruction. African American women were 30 % less likely to receive breast reconstruction than Caucasian women.ConclusionThese findings suggest that racial disparities in breast reconstruction persist in comprehensive cancer centers. Future research should further delineate the determinants of breast reconstruction disparities across various types of healthcare institutions. Only then can we develop interventions to ensure all eligible women have access to breast reconstruction and the improved quality of life it affords breast cancer survivors.

Abstract C08: Multilevel determinants of disparities in breast reconstruction: A systematic review

Abstract Context and Objectives: Breast reconstruction has been shown to yield important psycho-social and quality of life benefits for patients with breast cancer who have undergone mastectomy. However, a number of studies have demonstrated significant disparities in access to breast reconstruction. The Women's Health and Cancer Rights Act, which mandated insurance coverage of post mastectomy breast reconstruction in 1999 sought to improve access and reduce disparities but disparities continue to persist in spite of legislative action. Previous studies have established the presence of racial, income, insurance and geographic variation in breast reconstruction. However, no systematic review of these multiple disparities has been conducted. This study has two aims: 1) To conduct a quantitative assessment of the magnitude of multiple disparities in breast reconstruction and 2) To conduct a qualitative and quantitative assessment of multi-level determinants of these disparities. Methods: 43 relevant articles published from 1999 to 2015 were obtained through electronic database searches (PubMed) and manual searches of reference lists. English-language studies from United States were included if study objectives included examination of non-clinical patient level, provider level, institution level or geographic level determinants of Breast Reconstruction surgery after Mastectomy. Both qualitative and quantitative studies were included. Data were extracted and rated for study quality by one reviewer. Findings: Reconstruction rates varied from 6% to 53% in the studies reviewed based on the population assessed and the data used. Implants were more likely to be performed than autologous reconstruction. African Americans and Hispanics, patients with Medicare and Medicaid and patients residing in areas with median income in the lowest quartile were less likely to receive reconstructions. A consistent association was seen between increasing patient age and decreasing likelihood of reconstruction. Another significant and consistent association was between African American race and autologous versus implant reconstruction. Conclusions: Socioeconomic disparities in breast reconstruction remain pervasive in spite of legislation such as the Women's Health and Cancer Rights Act (WHCRA) and the Affordable Care Act, with substantial variation by racial or ethnic subgroup, median income of area of residence and payer. Factors explaining these disparities include variation in access to early diagnosis (later stage patients are less likely to get reconstruction), access to information regarding reconstruction (due to language barriers or provider bias) and in access to providers and institutions with high volumes of reconstruction. Other non-clinical patient level factors that influence reconstruction include patient preferences (religious preferences, body image perception, importance of feeling whole again, etc.), marital status, education, employment status, etc. Plastic surgeon characteristics include age and years in practice. Institutional characteristics include setting, teaching status, region, affiliation with an oncology group or national cancer centers, presence of residents, etc. Future reviews should focus on identifying interventions to successfully reduce these disparities in breast reconstruction. New Contribution: Although there have been two systematic reviews which look at socioeconomic and other determinants of breast reconstruction, neither of them focus only on United States nor do they include sufficient number of studies conducted after the Affordable Care Act in order to determine its impact on socioeconomic disparities. Additionally, neither of the two studies look at multi-level determinants of breast reconstruction and the type of reconstruction nor do they rate the quality of the studies included in the review. Thus, this review will address these gaps and make a significant and new contribution to literature. Citation Format: Jaya S. Khushalani. Multilevel determinants of disparities in breast reconstruction: A systematic review. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C08.

The influence of race/ethnicity and place of service on breast reconstruction for Medicare beneficiaries with mastectomy.

Racial disparities in breast reconstruction for breast cancer are documented. Place of service has contributed to disparities in cancer care; but the interaction of race/ethnicity and place of service has not been explicitly examined. We examined whether place of service modified the effect of race/ethnicity on receipt of reconstruction.We included women with a mastectomy for incident breast cancer in SEER-Medicare from 2005–2009. Using Medicare claims, we determined breast reconstruction within 6 months. Facility characteristics included: rural/urban location, teaching status, NCI Cancer Center designation, cooperative oncology group membership, Disproportionate Share Hospital (DSH) status, and breast surgery volume. Using multivariable logistic regression, we analyzed reconstruction in relation to minority status and facility characteristics.Of the 17,958 women, 14.2% were racial/ethnic women of color and a total of 9.3% had reconstruction. Caucasians disproportionately received care at non-teaching hospitals (53% v. 42%) and did not at Disproportionate Share Hospitals (77% v. 86%). Women of color had 55% lower odds of reconstruction than Caucasians (OR = 0.45; 95% CI 0.37-0.55). Those in lower median income areas had lower odds of receiving reconstruction, regardless of race/ethnicity. Odds of reconstruction reduced at rural, non-teaching and cooperative oncology group hospitals, and lower surgery volume facilities. Facility effects on odds of reconstruction were similar in analyses stratified by race/ethnicity status.Race/ethnicity and facility characteristics have independent effects on utilization of breast reconstruction, with no significant interaction. This suggests that, regardless of a woman’s race/ethnicity, the place of service influences the likelihood of reconstruction.

Health Insurance Coverage and Racial Disparities in Breast Reconstruction After Mastectomy

BackgroundBreast reconstruction after mastectomy offers clinical, cosmetic, and psychological benefits compared with mastectomy alone. Although reconstruction rates have increased, racial/ethnic disparities in breast reconstruction persist. Insurance coverage facilitates access to care, but few studies have examined whether health insurance ameliorates disparities. MethodsWe used the Nationwide Inpatient Sample for 2002 through 2006 to examine the relationships between health insurance coverage, race/ethnicity, and breast reconstruction rates among women who underwent mastectomy for breast cancer. We examined reconstruction rates as a function of the interaction of race and the primary payer (self-pay, private health insurance, government) while controlling for patient comorbidity, and we used generalized estimating equations to account for clustering and hospital characteristics. FindingsMinority women had lower breast reconstruction rates than White women (adjusted odds ratio [AOR], 0.57 for African American; AOR, 0.70 for Hispanic; AOR, 0.45 for Asian; p < .001). Uninsured women (AOR, 0.33) and those with public coverage were less likely to undergo reconstruction (AOR, 0.35; p < .001) than privately insured women. Racial/ethnic disparities were less prominent within insurance types. Minority women, whether privately or publicly insured, had lower odds of undergoing reconstruction than White women. Among those without insurance, reconstruction rates did not differ by race/ethnicity. ConclusionsInsurance facilitates access to care, but does not eliminate racial/ethnic disparities in reconstruction rates. Our findings—which reveal persistent health care disparities not explained by patient health status—should prompt efforts to promote both access to and use of beneficial covered services for women with breast cancer.

Racial/ethnic disparities in breast reconstruction after mastectomy

6510 Background: There is concern that minority women have limited access to breast reconstruction despite federally mandated insurance coverage. Our purpose was to describe patterns of use, decisi...