Community Factors Predict Reconstruction After Mastectomy

According to new research published in the November issue of Archives
of Surgery, women who live in wealthier communities with
lower population densities and a larger proportion of college-educated
individuals are more likely to have immediate breast reconstruction
after mastectomy.



Every year in the Unites States, breast cancer affects 134 of every
100,000 women. Surgical removal of the breast - or mastectomy - is a
treatment that many women choose, and it can be followed by
reconstructive breast surgery either immediately or after a
delay. "Immediate reconstruction has been shown to be superior
to delayed reconstruction for overall aesthetics, psychosocial
well-being and cost-effectiveness," write author Gedge D. Rosson, M.D.
(Johns Hopkins University School of Medicine, Baltimore) and
colleagues. "With these established benefits of immediate breast
reconstruction, we hypothesized that we could use immediate
reconstruction as a surrogate for optimal therapy and access to care
for patients undergoing mastectomy."



Rosson and colleagues studied 18,690 patients (about 60.1 years old) in
Maryland who underwent mastectomy between 1995 and 2004. The
researchers collected demographic information on the patients'
communities from a software program that is commercially available.



Focusing on the 17,925 patients who were white or African-American, the
researchers found that 27.9% of these (4,994 of 17,925) received
mastectomy and breast reconstruction during the same hospitalization.
The authors write: "We found that increasing income and increasing
population density of the city in which the patient lives had
statistically significant positive associations with the likelihood of
immediate breast reconstruction." They add that, "African American
race/ethnicity, older age, increasing percentage of the patient's
neighborhood with a high school education or less and increasing
African American composition of the patient's neighborhood had
statistically significant negative associations."



Specifically, compared to white women, African-Americans were 47% less
likely to undergo reconstruction during the mastectomy procedure. The
likelihood of joint procedures also decreased as age increased.
Community factors associated with access to immediate reconstruction
maintained their significance even when patient characteristics were
taken into account.



"In clinical medicine, we normally treat individuals, but this
multilevel database analysis points to the need also to evaluate the
community in which the patient lives," conclude Rosson and
colleagues. "The racial/ethnic mix, mean [average] income and
education level of the neighborhood and community are associated with
breast cancer management outcomes. Prospective public health measures,
including educational and informative programs, can be developed and
implemented in the community to address these inequalities
(particularly racial/ethnic disparities based on neighborhood) and to
increase the likelihood that patients with breast cancer and mastectomy
obtain immediate reconstruction."



Multilevel
Analysis of the Impact of Community vs Patient Factors on Access to
Immediate Breast Reconstruction Following Mastectomy in Maryland

Gedge D. Rosson, MD; Navin K. Singh, MD, MSc, MBA; Nita Ahuja, MD; Lisa
K. Jacobs, MD; David C. Chang, PhD, MPH, MBA

Archives of Surgery (2008). 143[11]:
pp. 1076 - 1081.

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Here to View Abstract



: Peter M Crosta