title: Disparities in reconstruction rates after mastectomy for ductal carcinoma in situ (DCIS): patterns of care and factors associated with the use of breast reconstruction for DCIS compared with invasive cancer.
abstract: BACKGROUND
  Many factors influence whether breast cancer patients undergo reconstruction after mastectomy. This study was undertaken to determine the patterns of care and variables associated with the use of reconstruction for ductal carcinoma in situ (DCIS) and to compare previous results for invasive carcinoma.
  
  
  METHODS
  Postmastectomy reconstruction rates were collected from the California Office of Statewide Health Planning and Development (OSHPD) for 2003-2007. International Classification of Disease-9 codes were used to identify patients undergoing reconstruction after mastectomy. Variations in reconstruction rates were examined by type of breast cancer (DCIS vs. invasive), calendar year, age, type of insurance, type of hospital, and race/ethnicity. Univariate and multivariate odds ratios (OR) with 95% confidence intervals (CI) were estimated for relative odds of immediate reconstruction versus mastectomy only.
  
  
  RESULTS
  For multivariate analysis, age, race/ethnicity, type of insurance, and type of hospital were significantly associated with the use of reconstruction for DCIS patients. DCIS patients were twice as likely to undergo reconstruction as patients with invasive cancer (odds ratio (OR) = 1.93, 95% confidence interval (CI) = 1.75-2.13). DCIS patients with private insurance were nine times more likely to undergo reconstruction as patients with Medicaid (OR = 8.84, 95% CI = 5.92-13.21). Both Hispanic white and Asian patients were one-fifth as likely to undergo reconstruction compared with non-Hispanic white patients (OR = 0.18, 95% CI = 0.1-0.3; OR = 0.17, 95% CI = 0.09-0.31).
  
  
  CONCLUSIONS
  Postmastectomy rates for DCIS were twice those for invasive cancer mostly because stage was not a limiting factor. However, significant factors remain that limit the use of reconstruction in this breast cancer population: age, race/ethnicity, type of hospital, and type of insurance.
authors.affiliation: General and Oncologic Surgery, City of Hope, USA. lkruper@coh.org
authors.forename: Laura
authors.initials: L
authors.lastname: Kruper
authors.forename: Xinxin
authors.initials: X
authors.lastname: Xu
authors.forename: Katherine
authors.initials: K
authors.lastname: Henderson
authors.forename: Leslie
authors.initials: L
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D016462:Mammaplasty / Q000523:psychology / Q000706:statistics & numerical data*; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010347:Patient Care Planning; D011379:Prognosis