Closing the Gap: Disparities in Breast Reconstruction After Mastectomy

Disparities in post-mastectomy breast reconstruction exist. In 2010, New York passed the Breast Cancer Provider Discussion Law (BCDL) mandating physicians to counsel patients on reconstructive options. This study aimed to assess disparities in breast reconstruction in New York City (NYC) and the impact of the BCDL.

The INSIGHT Clinical Research Network was used to identify female breast cancer patients (age ≥ 18 years) who underwent mastectomy between 2012 and 2021 in the NYC region. Clinical variables, demographics, and neighborhood socioeconomic factors were compared between patients who received reconstruction and those who did not using chi-square, one-way ANOVA, and Welch's two-sample t test. Differences in reconstruction rates over time by race and ethnicity were assessed using multivariate logistic regression.

Among 4959 patients identified, 68% underwent reconstruction. The patients who received reconstruction were younger (mean age, 51 vs 63 years; p < 0.001), had a lower BMI (mean 25.5 vs 27.1 kg/m²; p < 0.001) and Charlson comorbidity scores (mean 1.36 vs 1.64; p < 0.001), and lived in neighborhoods with higher median income (mean, $95,985 vs $87,999; p < 0.001). Since implementation of the BCDL, the disparity gap in reconstruction rates between non-Hispanic Black and non-Hispanic White patients has significantly decreased, from 23.1 to 1.6% between 2012 and 2021. A comparable gap between Hispanic and non-Hispanic White patients (10.3%) also closed during this period.

Race, age, and socioeconomic status significantly influence the likelihood of patients receiving post-mastectomy breast reconstruction. The BCDL has shown promise in reducing racial disparities in reconstruction throughout NYC, serving as a potential model for other communities to use in addressing similar health care inequities.