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Racial Disparities in Breast Reconstruction at a Comprehensive Cancer Center

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Introduction

Breast reconstruction after a mastectomy is an important component of breast cancer care that improves the quality of life in breast cancer survivors. African American women are less likely to receive breast reconstruction than Caucasian women. The purpose of this study was to further investigate the reconstruction disparities we previously reported at a comprehensive cancer center by assessing breast reconstruction rates, patterns, and predictors by race.

Methods

Data were obtained from women treated with definitive mastectomy between 2000 and 2012. Sociodemographic, tumor, and treatment characteristics were compared between African American and Caucasian women, and logistic regression was used to identify significant predictors of reconstruction by race.

Results

African American women had significantly larger proportions of public insurance, aggressive tumors, unilateral mastectomies, and modified radical mastectomies. African American women had a significantly lower reconstruction rate (35% vs. 49%, p < 0.01) and received a larger proportion of autologous reconstruction (13% vs. 7%, p < 0.01) compared to Caucasian women. The receipt of adjuvant radiation therapy was a significant predictor of breast reconstruction in Caucasian but not African American women.

Conclusions

We identified breast reconstruction disparities in rate and type of reconstruction. These disparities may be due to racial differences in sociodemographic, tumor, and treatment characteristics. The predictors of breast reconstruction varied by race, suggesting that the mechanisms underlying breast reconstruction may vary in African American women. Future research should take a target approach to examine the relative contributions of sociodemographic, tumor, and treatment determinants of the breast reconstruction disparities in African American women.

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Acknowledgements

The authors thank Ms. Lori Grove, Tumor Registrar, at the BJC Healthcare Cancer Registry, and Dr. Cassandra Arroyo, Lead Statistical Analyst, at Barnes Jewish Hospital, for their technical assistance with this manuscript.

Funding

This study and manuscript preparation were funded with grants from the National Cancer Institute (U54CA153460, G. Colditz, PI) and the Barnes-Jewish Foundation of BJC Healthcare.

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Authors and Affiliations

  1. Department of Social Sciences, College of Humanities and Social Sciences, University of Houston-Downtown, One Main Building N1027, Houston, TX, USA

    Shahnjayla K. Connors

  2. Department of Biostatistics, College of Global Public Health, New York University, New York, NY, USA

    Melody S. Goodman

  3. Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA

    Terence Myckatyn

  4. Section of Surgical Oncology, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA

    Julie Margenthaler

  5. Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA

    Sarah Gehlert

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  1. Shahnjayla K. Connors
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  3. Terence Myckatyn
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Contributions

Shahnjayla K. Connors, Melody S. Goodman, Terence Myckatyn, Julie Margenthaler, and Sarah Gehlert participated in study conception and design. Shahnjayla K. Connors and Melody S. Goodman participated in the acquisition, analysis, and interpretation of the data. All authors participated in the drafting and critical revision of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shahnjayla K. Connors.

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Ethics Approval

All procedures performed involving human participants have been approved by the appropriate institutional research ethics committee. The Human Research Protection Office (HRPO), the Institutional Review Board (IRB) at Washington University in St. Louis, approved this study.

Conflict of Interest

Dr. Myckatyn serves as a consultant for Allegan; Viveve Medical, Inc.; and RTI Surgical Holdings, Inc.; he has also received funding from Allergan and RTI Surgical Holdings. Dr. Margenthaler serves as a consultant for Genentech and Myriad Genetics, Inc. Dr. Connors, Dr. Goodman, and Dr. Gehlert declare no conflict of interest.

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Connors, S.K., Goodman, M.S., Myckatyn, T. et al. Racial Disparities in Breast Reconstruction at a Comprehensive Cancer Center. J. Racial and Ethnic Health Disparities 9, 2323–2333 (2022). https://doi.org/10.1007/s40615-021-01169-3

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