Insurance, Distance to Care Can Be Barriers to Breast Reconstruction
Women were less likely to have breast reconstruction surgery after mastectomy if they had Medicaid or Medicare rather than private insurance or if they lived 10 or more miles from a plastic surgeon’s office, a University of North Carolina (UNC) Lineberger Comprehensive Cancer Center study has found.
Researchers said the findings, published by Roughton et al in Plastic and Reconstructive Surgery, highlight additional barriers to breast reconstruction alongside other obstacles that have been identified including race, socioeconomic class, and age. The new data are concerning, researchers said, as the procedure can help with self-esteem, sexuality, and body image after cancer treatment.
“We know that breast cancer affects not only the physical well-being of the patient, but also her psychosocial well-being, and we know that breast reconstruction can help address those issues,” said the study’s first author, Michelle Roughton, MD, Assistant Professor of Surgery and Program Director for the UNC School of Medicine Section of Plastic and Reconstructive Surgery. “These findings highlight the fact that there are more barriers to breast reconstruction access than we previously recognized.”
Study Details
In the study, researchers analyzed insurance claims data for 5,381 women in North Carolina diagnosed with breast cancer between 2003 and 2006. The study included women with Medicaid, Medicare, or private insurance health plans, who had a mastectomy within 6 months of diagnosis and who continued to maintain their insurance coverage for at least 2 years after the procedure. Twenty percent of women included in the study chose breast reconstruction.
The study drew upon UNC Lineberger’s Integrated Cancer Information Surveillance System, a research tool that links population and clinical data to health claims data for about 5.5 million people insured by Medicare, Medicaid, or private insurance policies.
Key Findings
According to the unadjusted data, 56% of women with private insurance received breast reconstruction, compared with 10% of women with Medicare and 11% of those with Medicaid. The study found after adjusting for related patient factors such as age or stage of disease, Medicare recipients had 42% lower odds of receiving breast reconstruction than women with private insurance, and women with Medicaid had 76% lower odds.
“Even when you control for age, the type of insurance patients had was still an independent predictor of whether patients received breast reconstruction,” Dr. Roughton said.
By federal law, group health plans that pay for mastectomy must also cover breast prosthetics and reconstructive procedures. Medicare does cover the procedure, whereas Medicaid coverage can vary by state. Dr. Roughton said one factor affecting access to reconstruction may be that not all surgeons accept all types of insurance for the procedure.
Distance to the nearest plastic surgeon was also predictive of whether women underwent reconstruction. The study found that women living 20 or more miles away had 27% lower odds of receiving breast reconstruction compared to women living within 10 miles of a surgeon. Women living 10 to 20 miles away from the nearest surgeon had 22% lower odds.
The study also found that minority women had 50% lower odds of receiving reconstruction compared to non-Hispanic whites, and, consistent with previous studies, they found that increasing age at diagnosis, advanced cancer stage, and radiation treatment also decreased odds.
Dr. Roughton said she has tried to overcome distance obstacles for her patients by using telemedicine for initial consultations, and by using text and e-mail to help assess patients after the operation.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
