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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

  • Epidemiology
  • Published:
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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.

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Acknowledgments

Dr. Hershman is the recipient of a Grant from the National Cancer Institute (NCI R01 CA134964). Ms. Richards is the recipient of a T32 fellowship (NCI CA09529).

Conflict of interest

The authors have no potential conflicts of interest to report.

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Authors and Affiliations

  1. Department of Medicine, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, 161 Fort Washington Avenue, 10-1068, New York, NY, 10032, USA

    D. L. Hershman, K. Kalinsky & A. I. Neugut

  2. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA

    D. L. Hershman, C. A. Richards & A. I. Neugut

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

    D. L. Hershman, K. Kalinsky, A. I. Neugut & J. D. Wright

  4. Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY, USA

    E. T. Wilde

  5. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Y. S. Lu & J. D. Wright

  6. Division of Plastic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA

    J. A. Ascherman

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  1. D. L. Hershman
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Correspondence to D. L. Hershman.

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Hershman, D.L., Richards, C.A., Kalinsky, K. et al. 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. Breast Cancer Res Treat 136, 535–545 (2012). https://doi.org/10.1007/s10549-012-2273-4

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  • DOI: https://doi.org/10.1007/s10549-012-2273-4

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