Racial and ethnic disparities in the use of postmastectomy breast reconstruction: results from a population- based study.
OBJECTIVE
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. chi(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).


CONCLUSIONS
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.
Alderman
Amy K
AK
Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center Ann Arbor, MI 48109-0340, USA. aalder@umich.edu
Hawley
Sarah T
ST
Janz
Nancy K
NK
Mujahid
Mahasin S
MS
Morrow
Monica
M
Hamilton
Ann S
AS
Graff
John J
JJ
Katz
Steven J
SJ
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001943:Breast Neoplasms / Q000208:ethnology* / Q000601:surgery*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles; D016462:Mammaplasty / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000706:statistics & numerical data*; D008824:Michigan; D008875:Middle Aged; D015999:Multivariate Analysis; D018426:SEER Program / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult