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The effect of system-level access factors on receipt of reconstruction among Latina and white women with DCIS

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Treatment decisions associated with ductal carcinoma in situ (DCIS), including the decision to undergo breast reconstruction, may be more problematic for Latinas due to access and language issues. To help understand the factors that influence patients’ receipt of reconstruction following mastectomy for DCIS, we conducted a population-based study of English- and Spanish-speaking Latina and non-Latina white women from 35 California counties. The objectives of this study were to identify the role of ethnicity and language in the receipt of reconstruction, the relationship between system-level factors and the receipt of reconstruction, and women’s reasons for not undergoing reconstruction. Women aged 18 and older, who self-identified as Latina or non-Latino white and were diagnosed with DCIS between 2002 and 2005 were selected from eight California Cancer Registry (CCR) regions encompassing 35 counties. Approximately 24 months after diagnosis, they were surveyed about their DCIS treatment decisions. Survey data were merged with CCR records to obtain tumor and treatment data. The survey was successfully completed by 745 women, 239 of whom had a mastectomy and represent the sample included in this study. Whites had a higher completion rate than Latinas (67 and 55%, respectively). Analysis included descriptive statistics and logistic regression modeling. Mean age was 54 years. A greater proportion of whites had reconstruction (72%) compared to English-speaking Latinas (69%) and Spanish-speaking Latinas (40%). Multivariate analysis showed that women who were aged 65 and older, unemployed, and had a lower ratio of plastic surgeons in their county were less likely to have reconstructive surgery after mastectomy. The most frequent reasons mentioned not to receive reconstruction included lack of importance and desire to avoid additional surgery. Although ethnic/language differences in treatment selection were observed, multivariable analysis suggests that these differences could be explained by differential employment levels and geographic availability of plastic surgeons.

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Acknowledgments

This research was conducted with the support of the California Breast Cancer Research Program (9PB-0157). Dr. Karliner’s time is supported by a Mentored Scientist Research Grant (MSRG-060253-01) from the American Cancer Society. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer-reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s), and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred. We wish to thank Susan Duffey for her editorial assistance.

Financial disclosure

Dr. Hwang wishes to disclose research funding from Merck & Co., Inc.

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, University of California, P. O. Box 0856, San Francisco, CA, 94143-0856, USA

    Celia Patricia Kaplan, Leah S. Karliner, Susan Stewart, Dana Nickleach, Jessica Quinn, Angela Thrasher & Anna Maria Nápoles

  2. Medical Effectiveness Research Center for Diverse Populations, University of California, P. O. Box 0856, San Francisco, CA, 94143-0856, USA

    Celia Patricia Kaplan, Leah S. Karliner, Dana Nickleach, Jessica Quinn, Angela Thrasher & Anna Maria Nápoles

  3. Helen Diller Family Comprehensive Cancer Center, University of California, P. O. Box 0981, San Francisco, CA, 94143-0981, USA

    Celia Patricia Kaplan, Leah S. Karliner, E. Shelley Hwang, Susan Stewart & Anna Maria Nápoles

  4. School of Public Health, University of California, 247 E University Hall, P. O. Box 7360, Berkeley, CA, 94720-7360, USA

    Joan Bloom

  5. Department of Surgery, University of California, P. O. Box 1710, San Francisco, CA, 94143-1710, USA

    E. Shelley Hwang

Authors
  1. Celia Patricia Kaplan
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  2. Leah S. Karliner
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  3. E. Shelley Hwang
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  4. Joan Bloom
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  5. Susan Stewart
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  6. Dana Nickleach
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  7. Jessica Quinn
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  8. Angela Thrasher
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  9. Anna Maria Nápoles
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Correspondence to Celia Patricia Kaplan.

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Kaplan, C.P., Karliner, L.S., Hwang, E.S. et al. The effect of system-level access factors on receipt of reconstruction among Latina and white women with DCIS. Breast Cancer Res Treat 129, 909–917 (2011). https://doi.org/10.1007/s10549-011-1524-0

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  • DOI: https://doi.org/10.1007/s10549-011-1524-0

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