title: The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer.
abstract: BACKGROUND
  Multiple factors may influence whether patients undergo immediate breast reconstruction along with mastectomy for breast cancer. The authors investigated whether ethnicity was an independent predictor of immediate breast reconstruction.
  
  
  METHODS
  The authors identified 1004 patients who underwent mastectomy for breast cancer during the period 2001-2002. The rates of immediate reconstruction among different ethnicities were evaluated using the chi-square test. Logistic regression was used to adjust for covariates, including age and disease stage. Medical records were analyzed to identify factors that influenced each patient's decision for or against immediate breast reconstruction.
  
  
  RESULTS
  Three hundred seventy-six women (37.5%) underwent immediate breast reconstruction: This included 20.2% of African-American women, compared with 40.0% of white women, 42.0% of Hispanic women, 42.2% of Asian women, and 10.0% of Middle Eastern women (P < 0.001). The unadjusted odds ratio (OR) for immediate reconstruction for African-Americans versus whites was 0.38 (95% confidence interval [95% CI], 0.23-0.63; P < 0.001). After multivariate analysis, this disparity persisted, with an adjusted OR of 0.34 (95% CI, 0.18-0.62; P = 0.001). Asian women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.50; 95% CI, 0.24-1.04; P = 0.06). Hispanic women did not have immediate reconstruction rates that differed significantly from white women. Middle Eastern women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.08; 95% CI, 0.02-0.38; P = 0.002), but they had a corresponding increase in the rate of delayed reconstruction. In a stepwise analysis of the decision pathway to immediate reconstruction, it was found that African-American women were less likely to be offered referrals for reconstruction, were less likely to accept offered referrals, were less likely to be offered reconstruction, and were less likely to elect reconstruction if it was offered.
  
  
  CONCLUSIONS
  African-American women underwent immediate breast reconstruction at significantly lower rates compared with white women, Hispanic women, and Asian women. After adjusting for covariates, including age and disease stage, African-American women and Asian women had lower rates of reconstruction compared with white women. The factors that contribute to these differences warrant further study.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston 77030, USA.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kronowitz
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Sun
authors.forename: Allison C
authors.initials: AC
authors.lastname: Perry
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Newman
authors.forename: S Eva
authors.initials: SE
authors.lastname: Singletary
authors.forename: Nadeem Q
authors.initials: NQ
authors.lastname: Mirza
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Ames
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Robb
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
mesh_terms: D001741:Black or African American / Q000523:psychology; D001213:Asian / Q000523:psychology; D001943:Breast Neoplasms / Q000601:surgery*; D003657:Decision Making; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy; D008875:Middle Aged; D012189:Retrospective Studies; D044465:White People / Q000523:psychology