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Disparities in the Management of Pediatric Breast Masses
Maria E Knaus1, Amanda J Onwuka1, Alexis Bowder2
1Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio.
Insights
This study found no significant disparities in surgical timing for young females with breast masses based on race, insurance, or income. However, White patients were more likely to receive preoperative biopsies than Black patients.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Health Disparities Research
Background:
- Surgical management disparities exist across various diseases.
- Young females undergoing breast mass excision require investigation for sociodemographic differences.
Purpose of the Study:
- To investigate sociodemographic disparities in young females undergoing breast mass excision.
- To evaluate differences in patient characteristics, workup, management, and pathology by race/ethnicity, insurance status, median neighborhood income, and urbanicity.
Main Methods:
- Retrospective study of females aged 10-21 undergoing breast lesion surgery (2011-2016).
- Eleven pediatric hospitals participated.
- Bivariate and multivariable regression analyses were used to evaluate differences.
Main Results:
- 454 females included; median age 16 years.
- Patient demographics: 44% non-Hispanic Black, 40% non-Hispanic White, 7% Hispanic; 50% private insurance, 39% public.
- Non-Hispanic White patients had 4.5 times higher odds of preoperative biopsy than non-Hispanic Black patients; no other significant disparities in time to surgery, lesion size, or pathology.
Conclusions:
- No significant disparities found in time to surgery, lesion size, or pathology based on race/ethnicity, insurance, income, or urbanicity.
- Non-Hispanic White patients were more likely to undergo preoperative biopsy than non-Hispanic Black patients.
- The clinical utility of preoperative biopsy for pediatric breast masses is not well-established.
Introduction:
Disparities in surgical management have been documented across a range of disease processes. The objective of this study was to investigate sociodemographic disparities in young females undergoing excision of a breast mass.
Methods:
A retrospective study of females aged 10-21 y who underwent surgery for a breast lesion across eleven pediatric hospitals from 2011 to 2016 was performed. Differences in patient characteristics, workup, management, and pathology by race/ethnicity, insurance status, median neighborhood income, and urbanicity were evaluated with bivariate and multivariable regression analyses.
Results:
A total of 454 females were included, with a median age of 16 y interquartile range (IQR: 3). 44% of patients were nonHispanic (NH) Black, 40% were NH White, and 7% were Hispanic. 50% of patients had private insurance, 39% had public insurance, and 9% had other/unknown insurance status. Median neighborhood income was $49,974, and 88% of patients resided in a metropolitan area. NH Whites have 4.5 times the odds of undergoing preoperative fine needle aspiration or core needle biopsy compared to NH Blacks (CI: 2.0, 10.0). No differences in time to surgery from the initial imaging study, size of the lesion, or pathology were observed on multivariable analysis.
Conclusions:
We found no significant differences by race/ethnicity, insurance status, household income, or urbanicity in the time to surgery after the initial imaging study. The only significant disparity noted on multivariable analysis was NH White patients were more likely to undergo preoperative biopsy than were NH Black patients; however, the utility of biopsy in pediatric breast masses is not well established.
