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Stalled at the intersection: insurance status and disparities in post-mastectomy breast reconstruction

  • Clinical trial
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Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Post-mastectomy breast reconstruction (PMBR) is an important component of breast cancer treatment, but disparities relative to insurance status persist despite legislation targeting the issue. We aimed to study this relationship in a large health system combining a safety-net hospital and a private academic center.

Methods

Data were collected on all patients who underwent mastectomy for breast cancer from 2011 to 2019 in a private academic center and an adjacent public safety-net hospital served by the same surgical teams. Multivariable logistic regression was used to assess the effect of insurance status on PMBR, controlling for covariates that included socioeconomic, demographic, and clinical factors.

Results

Of 1554 patients undergoing mastectomy for breast cancer, 753 (48.5%) underwent PMBR, of which 592 (79.9%) were privately insured, 50 (6.7%) Medicare, 68 (9.2%) Medicaid, and 31 (4.2%) uninsured. Multivariable logistic regression showed a significantly higher likelihood of not undergoing PMBR for uninsured (OR 6.0, 95% CI 3.7–9.8; p < 0.0001), Medicare (OR 1.9, (95% CI 1.2–3.0; p = 0.006), and Medicaid (OR 1.5, 95% CI 1.0–2.3; p = 0.04) patients compared with privately insured patients. Age, stage, race and ethnicity, and hospital type confounded this relationship.

Conclusion

Patients without health insurance have dramatically reduced access to PMBR compared to those with private insurance. Expanding access to this important procedure is essential to achieve greater health equity for breast cancer patients.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Available from the corresponding author on reasonable request.

Abbreviations

AJCC:

American Joint Committee on Cancer

ASA:

American Society of Anesthesiologists

BMI:

Body Mass Index

CI:

Confidence interval

CPT:

Current procedural terminology

DAG:

Directed acyclic graph

OR:

Odds ratio

PMBR:

Post-mastectomy breast reconstruction

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

WHCRA:

Women’s Health and Cancer Rights Act

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Author notes

  1. Orli Friedman-Eldar and Jonathan Burke are co-first authors.

Authors and Affiliations

  1. Breast Surgical Oncology Department, Jackson Memorial Hospital, Miami, FL, USA

    Orli Friedman-Eldar

  2. Breast surgical Oncology Department, Kaplan Medical Center, Rehovot, Israel

    Orli Friedman-Eldar

  3. Department of Surgery, New York University School of Medicine, NewYork, NY, USA

    Jonathan Burke

  4. University of Miami, Miller School of Medicine, Miami, FL, USA

    Jonathan Burke, Camille C. Baumrucker & Fernando Valle

  5. Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Iago de Castro Silva, Dido Franceschi, Susan B. Kesmodel, Eli Avisar, Neha Goel & Mecker G. Möller

  6. University of El Salvador, San Salvador, El Salvador

    Fernando Valle

  7. Division of Plastic Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Anne-Sophie Lessard & Wrood Kassira

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  1. Orli Friedman-Eldar
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Contributions

OFE, JB and MGM: study conception and design. OFE, JB, IdCS, CCB, FVR and MGM: manuscript preparation, data collection and analysis. All authors read, reviewed, and approved the final manuscript.

Corresponding author

Correspondence to Orli Friedman-Eldar.

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Authors declare that they have no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the institutional Ethics Committee Grant No. 20053311.

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Friedman-Eldar, O., Burke, J., de Castro Silva, I. et al. Stalled at the intersection: insurance status and disparities in post-mastectomy breast reconstruction. Breast Cancer Res Treat 194, 327–335 (2022). https://doi.org/10.1007/s10549-022-06639-8

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