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The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer†
Article first published online: 23 AUG 2004
Copyright © 2004 American Cancer Society
Volume 101, Issue 7, pages 1514–1523, 1 October 2004
How to Cite
Tseng, J. F., Kronowitz, S. J., Sun, C. C., Perry, A. C., Hunt, K. K., Babiera, G. V., Newman, L. A., Singletary, S. E., Mirza, N. Q., Ames, F. C., Meric-Bernstam, F., Ross, M. I., Feig, B. W., Robb, G. L. and Kuerer, H. M. (2004), The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer. Cancer, 101: 1514–1523. doi: 10.1002/cncr.20529
Presented in part at the 57th annual meeting of the Society of Surgical Oncology, New York, New York, March 18–21, 2004.
- Issue published online: 17 SEP 2004
- Article first published online: 23 AUG 2004
- Manuscript Accepted: 22 JUN 2004
- Manuscript Received: 14 JUN 2004
- Del and Dennis McCarthy Fellowship in Experimental Surgery
- breast cancer;
- quality of care
Multiple factors may influence whether patients undergo immediate breast reconstruction along with mastectomy for breast cancer. The authors investigated whether ethnicity was an independent predictor of immediate breast reconstruction.
The authors identified 1004 patients who underwent mastectomy for breast cancer during the period 2001–2002. The rates of immediate reconstruction among different ethnicities were evaluated using the chi-square test. Logistic regression was used to adjust for covariates, including age and disease stage. Medical records were analyzed to identify factors that influenced each patient's decision for or against immediate breast reconstruction.
Three hundred seventy-six women (37.5%) underwent immediate breast reconstruction: This included 20.2% of African-American women, compared with 40.0% of white women, 42.0% of Hispanic women, 42.2% of Asian women, and 10.0% of Middle Eastern women (P < 0.001). The unadjusted odds ratio (OR) for immediate reconstruction for African-Americans versus whites was 0.38 (95% confidence interval [95% CI], 0.23–0.63; P < 0.001). After multivariate analysis, this disparity persisted, with an adjusted OR of 0.34 (95% CI, 0.18–0.62; P = 0.001). Asian women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.50; 95% CI, 0.24–1.04; P = 0.06). Hispanic women did not have immediate reconstruction rates that differed significantly from white women. Middle Eastern women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.08; 95% CI, 0.02–0.38; P = 0.002), but they had a corresponding increase in the rate of delayed reconstruction. In a stepwise analysis of the decision pathway to immediate reconstruction, it was found that African-American women were less likely to be offered referrals for reconstruction, were less likely to accept offered referrals, were less likely to be offered reconstruction, and were less likely to elect reconstruction if it was offered.
African-American women underwent immediate breast reconstruction at significantly lower rates compared with white women, Hispanic women, and Asian women. After adjusting for covariates, including age and disease stage, African-American women and Asian women had lower rates of reconstruction compared with white women. The factors that contribute to these differences warrant further study. Cancer 2004. © 2004 American Cancer Society.