title: A multi-institutional analysis of the socioeconomic determinants of breast reconstruction: a study of the National Comprehensive Cancer Network.
abstract: OBJECTIVE
  To determine the rate of postmastectomy reconstruction and investigate the impact of socioeconomic status on the receipt of reconstruction.
  
  
  BACKGROUND
  The National Comprehensive Cancer Network (NCCN) Outcomes Project is a prospective, multi-institutional database that contains data on all newly diagnosed breast cancer patients treated at one of the participating comprehensive cancer centers.
  
  
  METHODS
  The study cohort consisted of 2174 patients with DCIS and stage I, II, and III invasive breast cancer who underwent mastectomy at one of 8 NCCN centers. Rates of reconstruction were determined. Logistic regression analyses were used to evaluate whether socioeconomic characteristics are associated with breast reconstruction.
  
  
  RESULTS
  Overall, 42% of patients had breast reconstruction following mastectomy. Patients with Medicaid and Medicare were less likely to undergo reconstruction than those with managed care insurance; however, there was no difference for indemnity versus managed care insurance. Homemakers and retired patients had fewer reconstructions than those employed outside the home. Patients with a high school education or less were less likely to have reconstruction than those with more education. Race and ethnicity were not significant predictors of reconstruction.
  
  
  CONCLUSIONS
  The reconstruction rate in this study (42%) is markedly higher than those previously reported. The type of insurance, education level, and employment status of a patient, but not her race or ethnicity, appear to influence the use of breast reconstruction. Because all patients were treated at an NCCN institution, these socioeconomic differences cannot be explained by access to care.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, and Department of Breast Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Caprice K
authors.initials: CK
authors.lastname: Christian
authors.forename: Joyce
authors.initials: J
authors.lastname: Niland
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Edge
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Ottesen
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hughes
authors.forename: Richard
authors.initials: R
authors.lastname: Theriault
authors.forename: John
authors.initials: J
authors.lastname: Wilson
authors.forename: Charles A
authors.initials: CA
authors.lastname: Hergrueter
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D016015:Logistic Models; D016462:Mammaplasty / Q000191:economics / Q000706:statistics & numerical data*; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011446:Prospective Studies; D012923:Social Class; D012959:Socioeconomic Factors; D014481:United States