Investigators have identified disparities in the rates of breast reconstruction following mastectomy among American Indian and Alaskan Native women compared with non-Hispanic White women, according to a recent study published by White et al in Plastic and Reconstructive Surgery.
Background
Breast reconstruction following mastectomy has known benefits in some patients—including improved quality of life and body image. However, breast reconstruction is a personal decision; therefore, there is no optimal proportion of patients who should receive the procedure.
"Complicating the health-care environment in which [American Indian and Alaskan Native women] receive medical care is chronic underfunding of the Indian Health Service, implicit bias against [these patients], and fraught relationships between physicians and [American Indian and Alaskan Native] patients," the study authors suggested. American Indian and Alaskan Native women face a wide range of health disparities and barriers to medical care such as elevated rates of chronic health conditions, later diagnosis, and higher mortality from breast cancer.
“Despite an upward trend in reconstruction, [American Indian and Alaskan Native] women continue to be less likely to undergo breast reconstruction,” explained senior study author Jane Hui, MD, MS, of the University of Minnesota. “While our findings point to some possible approaches to reducing this disparity, it will be essential to also determine [American Indian and Alaskan Native] women's opinions related to breast reconstruction,” she continued.
Study Methods and Results
In the recent study, the investigators used data from the National Cancer Database to identify 1,980 American Indian and Alaskan Native women and 414,036 non-Hispanic White women who underwent mastectomy for breast cancer between 2004 and 2017. They then compared the annual rates of breast reconstruction and factors associated with reconstruction-related decisions between the two groups.
Compared with non-Hispanic White women, the investigators noted that the American Indian and Alaskan Native women had higher rates of comorbidities (20% vs 12%), were more likely to have public health insurance (49% vs 20%), and had a higher likelihood of undergoing unilateral mastectomy. Over the 13-year study period, breast reconstruction increased from 13% to 47% among American Indian and Alaskan Native women and from 29% to 62% among non-Hispanic White women. After adjusting for other factors, American Indian and Alaskan Native women remained nearly one-half less likely to undergo breast reconstruction.
Factors associated with lower breast reconstruction rates included older age, younger age at diagnosis, more advanced cancer, unilateral mastectomy, public insurance, and residence an area of lower educational attainment. Further, among the American Indian and Alaskan Native women, breast reconstruction was more likely to be received in younger women; those with more recent diagnosis, less advanced cancer, and less comorbidities; and those living in urban areas or areas with a higher level of educational attainment.
Conclusions
The findings may offer insights into the factors associated with lower rates of breast reconstruction in American Indian and Alaskan Native women with breast cancer.
“Multidisciplinary efforts to improve care delivery to [American Indian and Alaskan Native] women may continue to minimize disparities through earlier diagnosis and treatment,” Dr. Hui underscored. “Simultaneously, qualitative research into [American Indian and Alaskan Native] perspectives on breast cancer care could improve shared decision-making between physicians and … patients, empowering [American Indian and Alaskan Native] women to choose postmastectomy reconstruction if they so desire,” she concluded.
Disclosure: For full disclosures of the study authors, visit journals.lww.com.
