Community Factors Predict Reconstruction After Mastectomy

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Main Category: Breast Cancer
Also Included In: Cancer / Oncology;  Women's Health / Gynecology
Article Date: 19 Nov 2008 - 0:00 PDT

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According to new research published in the November issue of Archives of Surgery, women who live in wealthier communities with lower population densities and a larger proportion of college-educated individuals are more likely to have immediate breast reconstruction after mastectomy.

Every year in the Unites States, breast cancer affects 134 of every 100,000 women. Surgical removal of the breast - or mastectomy - is a treatment that many women choose, and it can be followed by reconstructive breast surgery either immediately or after a delay. "Immediate reconstruction has been shown to be superior to delayed reconstruction for overall aesthetics, psychosocial well-being and cost-effectiveness," write author Gedge D. Rosson, M.D. (Johns Hopkins University School of Medicine, Baltimore) and colleagues. "With these established benefits of immediate breast reconstruction, we hypothesized that we could use immediate reconstruction as a surrogate for optimal therapy and access to care for patients undergoing mastectomy."

Rosson and colleagues studied 18,690 patients (about 60.1 years old) in Maryland who underwent mastectomy between 1995 and 2004. The researchers collected demographic information on the patients' communities from a software program that is commercially available.

Focusing on the 17,925 patients who were white or African-American, the researchers found that 27.9% of these (4,994 of 17,925) received mastectomy and breast reconstruction during the same hospitalization. The authors write: "We found that increasing income and increasing population density of the city in which the patient lives had statistically significant positive associations with the likelihood of immediate breast reconstruction." They add that, "African American race/ethnicity, older age, increasing percentage of the patient's neighborhood with a high school education or less and increasing African American composition of the patient's neighborhood had statistically significant negative associations."

Specifically, compared to white women, African-Americans were 47% less likely to undergo reconstruction during the mastectomy procedure. The likelihood of joint procedures also decreased as age increased. Community factors associated with access to immediate reconstruction maintained their significance even when patient characteristics were taken into account.

"In clinical medicine, we normally treat individuals, but this multilevel database analysis points to the need also to evaluate the community in which the patient lives," conclude Rosson and colleagues. "The racial/ethnic mix, mean [average] income and education level of the neighborhood and community are associated with breast cancer management outcomes. Prospective public health measures, including educational and informative programs, can be developed and implemented in the community to address these inequalities (particularly racial/ethnic disparities based on neighborhood) and to increase the likelihood that patients with breast cancer and mastectomy obtain immediate reconstruction."

Multilevel Analysis of the Impact of Community vs Patient Factors on Access to Immediate Breast Reconstruction Following Mastectomy in Maryland
Gedge D. Rosson, MD; Navin K. Singh, MD, MSc, MBA; Nita Ahuja, MD; Lisa K. Jacobs, MD; David C. Chang, PhD, MPH, MBA
Archives of Surgery (2008). 143[11]: pp. 1076 - 1081.
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Written by: Peter M Crosta
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