Local practice variations and payer differences underlie state-wide disparities in oncoplastic breast surgery

Area of Science:

• Oncoplastic surgery
• Breast cancer treatment
• Health services research

Background:

• Disparities in oncoplastic breast surgery delivery are not well understood.
• Oncoplastic surgery aims to improve aesthetic outcomes following breast cancer lumpectomy.

Purpose of the Study:

• To investigate disparities in the delivery of oncoplastic breast surgery.
• To identify factors associated with the receipt of oncoplastic surgery after lumpectomy.

Main Methods:

• Analysis of the Massachusetts All-Payer Claims Database (2016-2020).
• Inclusion of patients diagnosed with breast cancer who underwent lumpectomy.
• Definition of oncoplastic surgery encompassing various reconstructive techniques.

Main Results:

• 18,748 patients underwent lumpectomy; 3,140 had immediate and 436 delayed oncoplastic surgery.
• Public insurance status was associated with lower odds of receiving oncoplastic surgery (OR: 0.87).
• Average payments for oncoplastic surgery were significantly higher for privately insured patients ($1942 vs. $840).

Conclusions:

• Disparities in oncoplastic surgery receipt are linked to local practice variations and insurance type.
• Geographic and insurance-based inequities in access to oncoplastic breast surgery were identified.
• Recommendations include expanding services across counties and exploring billing reforms to mitigate disparities.