Few women receive immediate postmastectomy breast reconstruction
MedWire News: Less than a quarter of women with breast cancer undergo immediate postmastectomy breast reconstruction, despite guidelines recommending that the procedure should be available to all patients.
"Insurance status was one of the largest predictors of immediate breast reconstruction, and its influence has increased over time," said Dawn Hersman (Columbia University Medical Center, New York, USA) at the CTRC-AACR San Antonio Breast Cancer Symposium in San Antonio, Texas, USA.
Hersman and her team evaluated the association of demographic, hospital, physician, and insurance factors with receipt of immediate breast reconstruction among patients with breast cancer (n=108,992) and ductal carcinoma in situ (DCIS; n=14,710) who underwent mastectomy between 2000 and 2010. The women were identified from a hospital-based commercial database that covers around 15% of US hospitals.
Overall, 23.4% of women with breast cancer and 36.4% of those with DCIS received immediate reconstruction (IR). During the study period, reconstruction rates increased substantially in women with commercial insurance, from 25.3% in 2000 to 54.6% in 2010, but only moderately among women with Medicare insurance, from 7% to 13%.
Furthermore, multivariable analysis revealed that women with commercial insurance were 2.9 times more likely to receive IR than those who were self-paying.
Age also influenced IR rates with women younger than 40 years and aged 40-49 years 1.82 and 1.56 times more likely to undergo the procedure, respectively, than women aged 50-59 years. Older women, aged 60-69 years and aged 70 years and older were less likely to receive IR than those aged 50-59 years, at odds ratios (ORs) of 0.68 and 0.22, respectively.
Black race (OR=0.66), rural hospital location (OR=0.48), nonteaching hospital (OR=0.82), and two or co-morbid conditions (OR=0.72) were also associated with a lower likelihood for IR.
By contrast, women who had bilateral mastectomies (vs unilateral; OR=2.50), those who were single (vs married; OR=1.09), and those treated at a high-volume hospital (vs low-volume; OR=1.94) were all more likely to undergo IR.
Hershman pointed out that the Women's Health and Cancer Rights Act of 1998 mandates health insurance/health maintenance organizations must cover reconstruction cost.
In spite of this, these data appear to show that women with different insurance types do not have equal access to IR.
"Public policy should ensure that access to reconstructive surgery is available to all women, regardless of insurance type," Hershman concluded.
MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Laura Dean