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Regional Market Competition and the Use of Immediate Breast Reconstruction After Mastectomy

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Prior work has shown that the competitiveness of the market in which hospitals operate is associated with use of surgical procedures. This study examined the association between regional market competition and use of breast reconstruction for women with breast cancer and ductal carcinoma in situ undergoing mastectomy.

Methods

Women who underwent mastectomy from 2010 to 2011 recorded in the National Inpatient Sample were selected. The competitive market environment for each hospital in which patients were treated was estimated using the Herfindahl–Hirschman Index. Multivariable models were developed to examine the association between regional market competition and breast reconstruction, with adjustment for other clinical, demographic, and structural variables.

Results

Immediate breast reconstruction was performed for 9902 (45%) of 22,011 women. The rate of immediate breast reconstruction was 34.5% at hospitals in non-competitive markets, 49% at hospitals in moderately competitive markets, and 56.4% at hospitals in highly competitive markets (P < 0.0001). In a multivariable model, women in moderately competitive markets were 24% (risk ratio [RR] 1.24; 95% confidence interval [CI] 1.10–1.41) more likely to undergo immediate breast reconstruction than women in noncompetitive markets, whereas those in competitive markets were 25% (RR 1.25; 95% CI 1.11–1.41) more likely to have reconstruction. Later year of treatment, higher census tract income level, and residence in an urban area were associated with an increased likelihood of reconstruction (P < 0.05 for all). In contrast, older age, non-white race, and non-commercial insurance were associated with a lower likelihood of reconstruction (P < 0.05 for all).

Conclusion

Patients who undergo mastectomy at hospitals in competitive markets are more likely to undergo immediate breast reconstruction.

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Acknowledgment

Dr. Jason D. Wright (NCI R01CA169121-01A1) is a recipient of a grant from the National Cancer Institute. Dr. Dawn L. Hershman is the recipient of grants from the Breast Cancer Research Foundation, the Conquer Cancer Foundation, and the Susan Komen Foundation.

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Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 4th Floor, New York, USA

    Jason D. Wright MD, Ling Chen MD, MPH, Melissa Accordino MD, Bret Taback MD, Alfred I. Neugut MD, PhD & Dawn L. Hershman MD

  2. Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, USA

    Jason D. Wright MD, Melissa Accordino MD, Alfred I. Neugut MD, PhD & Dawn L. Hershman MD

  3. New York Presbyterian Hospital, New York, USA

    Jason D. Wright MD, Melissa Accordino MD, Alfred I. Neugut MD, PhD & Dawn L. Hershman MD

  4. Mailman School of Public Health, Columbia University, New York, USA

    Cande V. Ananth PhD, MPH, Alfred I. Neugut MD, PhD & Dawn L. Hershman MD

Authors
  1. Jason D. Wright MD
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  2. Ling Chen MD, MPH
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  3. Melissa Accordino MD
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  6. Alfred I. Neugut MD, PhD
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  7. Dawn L. Hershman MD
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Correspondence to Jason D. Wright MD.

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Disclosure

Dr. Jason D. Wright has served as a consultant for Tesaro and Clovis Oncology. Dr. Neugut has served as a consultant to Pfizer, Teva, Eisai, Otsuka, and United Biosource Corporation. He is on the medical advisory board of EHE, International. No other authors have any conflicts of interest or disclosures.

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Wright, J.D., Chen, L., Accordino, M. et al. Regional Market Competition and the Use of Immediate Breast Reconstruction After Mastectomy. Ann Surg Oncol 26, 62–70 (2019). https://doi.org/10.1245/s10434-018-6825-7

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