Originally published as JCO Early Release 10.1200/JCO.2009.22.2455 on October 5 2009

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Google Scholar Articles by Alderman, A. K. Articles by Katz, S. J. PubMed PubMed Citation Articles by Alderman, A. K. Articles by Katz, S. J. Social Bookmarking                            What's this?

Racial and Ethnic Disparities in the Use of Postmastectomy Breast Reconstruction: Results From a Population- Based Study

From the Section of Plastic Surgery, Department of Surgery, and Division of General Medicine, Department of Internal Medicine, University of Michigan Medical Center; Department of Health Behavior and Health Education, University of Michigan School of Public Health; Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Health Care System, Ann Arbor; Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Robert Wood Johnson Health and Society Scholar, Harvard School of Public Health, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Corresponding author: Amy K. Alderman, MD, MPH, Assistant Professor of Surgery, Plastic and Reconstructive Surgery, University of Michigan, 2130 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0340; e-mail: aalder{at}umich.edu.

Purpose There is concern that minority women have limited access to breast reconstruction. We described patterns of use, experiences with clinicians, and patients' satisfaction with treatment decisions for women of different race/ethnicities.

Methods A total of 3,252 patients with breast cancer from Los Angeles and Detroit Surveillance, Epidemiology, and End Results registries were surveyed near the time of diagnosis (n = 2,260, response rate 72.2%). The primary outcomes were receipt of reconstruction, access to information about reconstruction, and decisional satisfaction. The primary independent variable was race/ethnicity (white, African American [AA], highly acculturated Latina [Latina-high], and less acculturated Latina [Latina-low]). Control variables included other sociodemographic and clinical factors. ² and multivariate logistic regression were used for the analyses.

Results Receipt of reconstruction varied significantly by patient race/ethnicity—40.9% of whites, 33.5% of AAs, 41.2% of Latina-high, and only 13.5% of Latina-low (P < .001)—and persisted when we controlled for demographic and clinical factors. Minority women were significantly less likely than whites to see a plastic surgeon before initial surgery and were more likely to desire more information about reconstruction (17.0% of whites v 27.0% of AAs, 30.0% of Latina-high, and 55.9% of Latina-low; P < .001). Decisional satisfaction was lowest among minority women without reconstruction (P < .001).

Conclusion Minority women, particularly less acculturated Latinas, had low receipt of breast reconstruction, which may be related to limited information about the procedure and less access to plastic surgeons. Greater desire for information and lower satisfaction with surgical decisions among these patients motivate greater attention to treatment support for these patients.

The ideas and opinions expressed herein are those of the authors and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?