Disparities Persist in Postmastectomy Reconstruction

TUESDAY, July 23, 2024 (HealthDay News) -- Postmastectomy reconstruction (PMR) rates among American Indian/Alaska Native (AI/AN) women with breast cancer increased from 2004 to 2017, but remain significantly lower than rates among non-Hispanic White (NHW) women, according to a study published in the July issue of Plastic and Reconstructive Surgery.

McKenzie J. White, M.D., from the University of Minnesota in Minneapolis, and colleagues examined factors associated with disparities in PMR surgical care. The National Cancer Database (2004 to 2017) was used to identify 414,036 NHW and 1,980 AI/AN women (aged 18 to 64) who underwent mastectomy for stage 0 to III breast cancer.

The researchers found that compared to NHW women, AI/AN women had more comorbidities (20 versus 12 percent), more often had nonprivate insurance (49 versus 20 percent), and more frequently underwent unilateral mastectomy (69 versus 61 percent). Over the study period, PMR rates increased from 13 to 47 percent for AI/AN women and from 29 to 62 percent for NHW women. There was an independent association between AI/AN race and decreased likelihood of PMR (odds ratio, 0.62). Among AI/AN women, there were significant associations between older age at diagnosis, more remote year of diagnosis, advanced disease (tumor size >5 cm and positive lymph nodes), unilateral mastectomy, nonprivate insurance, and lower educational attainment in patient’s area of residence with decreased likelihood of PMR.

"Multidisciplinary efforts to improve care delivery to AI/AN women may continue to minimize disparities through earlier diagnosis and treatment," the authors write. "Simultaneously, qualitative research into AI/AN perspectives on breast cancer care could improve shared decision-making between physicians and AI/AN patients, empowering AI/AN women to choose postmastectomy reconstruction if they so desire."

Abstract/Full Text