Closing the Gap: Disparities in Breast Reconstruction After Mastectomy

Area of Science:

• Oncology
• Public Health Policy
• Health Disparities Research

Background:

• Significant disparities exist in post-mastectomy breast reconstruction rates.
• New York's Breast Cancer Provider Discussion Law (BCDL), enacted in 2010, mandates physician counseling on reconstructive options.
• The law aims to address inequities in breast reconstruction access.

Purpose of the Study:

• To evaluate breast reconstruction disparities in New York City (NYC).
• To assess the impact of the BCDL on these disparities.
• To identify factors influencing reconstruction rates.

Main Methods:

• Utilized the INSIGHT Clinical Research Network to identify 4959 female breast cancer patients (age ≥ 18) undergoing mastectomy in NYC (2012-2021).
• Compared clinical variables, demographics, and neighborhood socioeconomic factors between patients who received reconstruction and those who did not.
• Employed chi-square, ANOVA, and logistic regression to analyze disparities and trends over time, particularly by race and ethnicity.

Main Results:

• 68% of patients underwent breast reconstruction.
• Reconstruction patients were younger, had lower BMI and comorbidity scores, and resided in higher-income neighborhoods.
• Post-BCDL implementation, racial disparities in reconstruction rates significantly decreased: the gap between non-Hispanic Black and White patients reduced from 23.1% to 1.6%, and the gap between Hispanic and White patients closed.

Conclusions:

• Race, age, and socioeconomic status are significant determinants of post-mastectomy breast reconstruction.
• The BCDL has demonstrated effectiveness in mitigating racial disparities in breast reconstruction within NYC.
• The BCDL serves as a potential model for other regions aiming to reduce healthcare inequities in breast reconstruction.