Despite steady increases in the rates of immediate postmastectomy breast reconstruction, racial disparities in receipt of the procedure have persisted in the years since the implementation of the Affordable Care Act (ACA), according to a recent study published by Schafer et al in Plastic and Reconstructive Surgery.
Background
Among patients undergoing mastectomy, breast reconstruction can restore form and enhance patient satisfaction. Several of the ACA’s provisions—such as expanding protections for preexisting conditions and reducing the number of uninsured U.S. patients—were designed to enhance health-care access to historically marginalized groups.
Study Methods and Results
Investigators used data from the American College of Surgeons’ National Surgical Quality Improvement Project to analyze trends in immediate breast reconstruction among 224,506 patients undergoing mastectomy prior to the passage of the ACA from 2005 to 2008 or following full ACA implementation from 2016 to 2022.
Prior to the passage of the ACA, the investigators found significant racial disparities in receipt of immediate breast reconstruction. For instance, reconstruction rates ranged from 35.1% in White patients to 28.8% in Asian patients, 22.3% in Black patients, and 3.8% in American Indian/Alaska Native patients. Hispanic patients were also less likely to undergo immediate breast reconstruction than non-Hispanic patients (28.0% vs 33.4%).
Following the ACA’s implementation, immediate breast reconstruction rates increased across racial groups. The largest increases were seen for American Indian/Alaska Native and Black patients, where rates rose by 27.6% and 24.2%, respectively, compared with 16.9% among White patients. Smaller but statistically significant increases were observed among Asian patients and those classified as "other" race. Hispanic patients had a 25.8% increase in immediate breast reconstruction compared with 14.5% among non-Hispanic patients.
However, racial minority groups continued to demonstrate lower immediate breast reconstruction rates in the years since the ACA’s rollout. From 2016 to 2022, the reconstruction rate was 52.0% among White patients compared with 46.5% among Black patients, 38.7% among Asian patients, and 31.4% among American Indian/Alaska Native patients. In contrast, Hispanic patients were more likely to undergo immediate breast reconstruction compared with non-Hispanic patients (56.6% vs 45.7%).
Conclusions
The findings indicated that there was a steady increase in immediate breast reconstruction rates across all minority groups compared with among White patients.
The investigators noted that important limitations of their study included its inability to account for the wide range of factors affecting access to reconstructive surgery or for the complex interplay of cultural, social, and individual factors impacting decision-making for breast reconstruction.
“Our study demonstrates that Hispanic women are more likely to undergo postmastectomy breast reconstruction compared [with] their non-Hispanic counterparts in the post-ACA era,” emphasized study author Rachel E. Schafer, MPH, a medical student at the Cleveland Clinic Lerner College of Medicine. “However, our analysis shows persistent racial disparities in breast reconstruction care. To better understand these trends, future studies are needed for targeted interventions to ensure equitable reconstructive care for all patients with breast cancer,” she concluded.
Disclosure: For full disclosures of the study authors, visit journals.lww.com.
