More Caucasian Than African-American Women Reconstruct

Patterns and correlates of breast reconstruction: Results of a population based study.

M. Morrow, P. Lantz, N. Janz, A. Fagerlin, M. Mujahid, S. Katz;

Northwestern University, Chicago, IL; University of Michigan, Ann Arbor, MI

Abstract: Background: Little is known about patterns and correlates of breast reconstruction (BR) for patients with breast cancer who undergo mastectomy in the community.

Methods: All women with DCIS and a 20% random sample of women with non-metastatic invasive breast cancer aged 79 and younger diagnosed in 2002 and reported to the Detroit and Los Angeles metropolitan SEER registries were identified and surveyed shortly after receipt of surgical treatment. Response rate was 74.3% (N=1489).

Results: The mean age was 59.9 years and 28.8% were non-Caucasian. Overall, 35.0% of women received M, of whom 30.8 % received BR. BR was more frequent for those with DCIS (53.8%) than those with Stage 1 (35.9%) or 2 (28.9%) invasive cancer.

In multivariate analyses, Caucasian race, earlier stage, younger age, and higher education levels were positively associated with BR. After adjustment for co-variates, 38.7% of Caucasian women had BR compared to 19.0% of African American women, and 20.9% of other races (p=.001).

In the subset of M patients who did not receive BR, the desire to avoid more surgery (35.5%), lack of importance of BR (43.7%), and lack of a surgeon recommendation (17.9%) were the most commonly cited reasons.

More African American than Caucasian women endorsed lack of knowledge about BR (9.2% vs 1.0%, p=.003) and lack of surgeon recommendation (26.2% vs 15.9%, p=.03) as reasons for not having the procedure.

Fewer African Americans than Caucasians reported that their surgeon discussed BR (48.9 vs 69.6%, p=.001). These differences remained significant after controlling for age, marital status and co-morbidity.

Conclusions: The majority of women undergoing M do not receive BR. Receipt of BR was highly associated with earlier stage, younger age, higher education, and Caucasian race.

Results suggest that patient-provider communication about treatment may contribute to the observed racial differences in receipt of BR.

Abstract No: 557

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