Breast Cancer Research and Treatment

, Volume 136, Issue 2, pp 535–545

Influence of health insurance, hospital factors and physician volume on receipt of immediate post-mastectomy reconstruction in women with invasive and non-invasive breast cancer

  • D. L. Hershman
  • C. A. Richards
  • K. Kalinsky
  • E. T. Wilde
  • Y. S. Lu
  • J. A. Ascherman
  • A. I. Neugut
  • J. D. Wright
Epidemiology

DOI: 10.1007/s10549-012-2273-4

Cite this article as:
Hershman, D.L., Richards, C.A., Kalinsky, K. et al. Breast Cancer Res Treat (2012) 136: 535. doi:10.1007/s10549-012-2273-4

Abstract

For women with breast cancer who undergo mastectomy, immediate breast reconstruction (IR) offers a cosmetic and psychological advantage. We evaluated the association between demographic, hospital, surgeon and insurance factors and receipt of IR. We conducted a retrospective hospital-based analysis with the Perspective database. Women who underwent a mastectomy for invasive breast cancer (IBC) and ductal carcinoma in situ (DCIS) from 2000 to 2010 were included. Logistic regression analysis was used to determine factors predictive of IR. Analyses were stratified by age (<50 vs. ≥50) and IBC versus DCIS. Of the 108,992 women with IBC who underwent mastectomy, 30,859 (28.3 %) underwent IR, as compared to 6,501 (44.2 %) of the 14,710 women with DCIS who underwent mastectomy underwent IR. In a multivariable model for IBC, increasing age, black race, being married, rural location, and increased comorbidities were associated with decreased IR. Odds ratios (OR) of IR increased with commercial insurance (OR 3.38) and Medicare (OR 1.66) insurance (vs. self-pay), high surgeon-volume (OR 1.19), high hospital-volume (OR 2.24), and large hospital size (OR 1.20). The results were identical for DCIS, and by age category. The absolute difference between the proportion of patients who received IR with commercial insurance compared to other insurance, increased over time. Immediate in-hospital complication rates were higher for flap reconstruction compared to implant or no reconstruction (15.2, 4.0, and 6.1 %, respectively, P < .0001). IR has increased significantly over time; however, modifiable factors such as insurance status, hospital size, hospital location, and physician volume strongly predict IR. Public policy should ensure that access to reconstructive surgery is universally available.

Keywords

Breast reconstructionInsuranceHospital volume

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • D. L. Hershman
    • 1
    • 2
    • 3
  • C. A. Richards
    • 2
  • K. Kalinsky
    • 1
    • 3
  • E. T. Wilde
    • 4
  • Y. S. Lu
    • 5
  • J. A. Ascherman
    • 6
  • A. I. Neugut
    • 1
    • 2
    • 3
  • J. D. Wright
    • 3
    • 5
  1. 1.Department of MedicineColumbia University College of Physicians and Surgeons, Columbia University Medical CenterNew YorkUSA
  2. 2.Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkUSA
  3. 3.Herbert Irving Comprehensive Cancer CenterColumbia University College of Physicians and SurgeonsNew YorkUSA
  4. 4.Department of Health Policy and ManagementColumbia University Mailman School of Public HealthNew YorkUSA
  5. 5.Department of Obstetrics and GynecologyColumbia University College of Physicians and SurgeonsNew YorkUSA
  6. 6.Division of Plastic SurgeryColumbia University College of Physicians and SurgeonsNew YorkUSA