title: Breast reconstruction after mastectomy among Department of Defense beneficiaries by race.
abstract: BACKGROUND
  Postmastectomy breast reconstruction increased approximately 20% between 1998 and 2008 in the United States and has been found to improve body image, self-esteem, and quality of life. These procedures, however, tend to be less common among minority women, which may be due to variations in health care access. The Department of Defense provides equal health care access, thereby affording an exceptional environment in which to assess whether racial variations persist when access to care is equal.
  
  
  METHODS
  Linked Department of Defense cancer registry and medical claims data were used. The receipt of reconstruction was compared between white women (n = 2974) and black women (n = 708) who underwent mastectomies to treat incident histologically confirmed breast cancer diagnosed from 1998 through 2007.
  
  
  RESULTS
  During the study period, postmastectomy reconstruction increased among both black (27.3% to 40.0%) and white (21.8% to 40.6%) female patients with breast cancer. Receipt of reconstruction did not vary significantly by race (odds ratio, 0.93; 95% confidence interval, 0.76-1.15). Reconstruction decreased significantly with increasing age, tumor stage, and receipt of radiotherapy and was significantly more common in more recent years and among active service women, TRICARE Prime (health maintenance organization) beneficiaries, and women whose sponsor was an officer.
  
  
  CONCLUSIONS
  The receipt of breast reconstruction did not vary by race within this equal-access health system, indicating that the racial disparities reported in previous studies may have been due in part to variations in access to health care. Additional research to determine why a large percentage of patients with breast cancer do not undergo reconstruction might be beneficial, particularly because these procedures have been associated with noncosmetic benefits.
authors: Health Services Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors: Lindsey R
authors: LR
authors: Enewold
authors: Katherine A
authors: KA
authors: McGlynn
authors: Shelia H
authors: SH
authors: Zahm
authors: Jill
authors: J
authors: Poudrier
authors: William F
authors: WF
authors: Anderson
authors: Craig D
authors: CD
authors: Shriver
authors: Kangmin
authors: K
authors: Zhu
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage; D016462:Mammaplasty / Q000191:economics / Q000706:statistics & numerical data*; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries; D014481:United States; D059030:United States Department of Defense; D044465:White People / Q000706:statistics & numerical data*
keywords: breast cancer; epidemiology; health care access; mastectomy; racial disparities; reconstruction