title: Socio-demographic, clinical, and health-related factors associated with breast reconstruction - A nationwide cohort study.
abstract: We collected registry- and questionnaire-based data on socio-economic and health status, tumor- and treatment-related variables, and explored associations with receipt of reconstruction and information about treatment options in a nationwide cohort of Danish women, treated for primary breast cancer. A total of 594 women were available for analysis, 240 (40%) of these received reconstruction. Multivariate analyses showed that receipt of reconstruction was associated with 1) younger age at time of primary surgery (<36 years: OR = 10.04, [3.80-26.50], p < 0.001 and 36-49 years: OR = 2.48, [1.73-3.56], p < 0.001, compared to 50-60 year olds), 2) having received radiotherapy (OR = 0.57, [0.40-0.81], p = 0.002), 3) high income (Second quartile: OR = 1.74, [1.05-2.90], p = 0.033 and fourth quartile: OR = 2.18, [1.31-3.62], p = 0.003, compared with the lowest income quartile), and 4) ethnicity other than Danish (OR = 6.32, [1.58-25.36], p = 0.009). Health-related factors at the time of primary surgery (physical functioning, body mass index, smoking, use of alcohol, and comorbidity) were not associated with reconstruction. Odds of having received information about the option of reconstruction decreased by 8% per year of age in the multivariate analysis (OR = 0.92, [0.87-0.97], p = 0.003). In conclusion, younger age and not having been treated with radiotherapy was independently associated with reconstruction. In addition, higher income was also found to be associated with reconstruction despite free and equal access to reconstruction and healthcare in Denmark. Healthrelated factors were not associated with the use of reconstruction following mastectomy. Our findings underscore the need for physicians to ensure optimal level of information and accessibility to reconstruction for all women regardless of age, treatment, and socio-economic status.
authors.affiliation: Department of Surgery P, Breast and Endocrine Section, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark. Electronic address: annebodi@rm.dk.
authors.forename: Anne
authors.initials: A
authors.lastname: Bodilsen
authors.affiliation: Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Bartholins Allé 9, Bld. 1340, 8000 Aarhus C, Denmark. Electronic address: soeren.christensen@aarhus.rm.dk.
authors.forename: Søren
authors.initials: S
authors.lastname: Christensen
authors.affiliation: Department of Surgery P, Breast and Endocrine Section, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark. Electronic address: peerchri@rm.dk.
authors.forename: Peer
authors.initials: P
authors.lastname: Christiansen
authors.affiliation: Department of Plastic Surgery, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark. Electronic address: tinedams@rm.dk.
authors.forename: Tine E
authors.initials: TE
authors.lastname: Damsgaard
authors.affiliation: Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Bartholins Allé 9, Bld. 1340, 8000 Aarhus C, Denmark. Electronic address: bzach@aarhus.rm.dk.
authors.forename: Robert
authors.initials: R
authors.lastname: Zachariae
authors.affiliation: Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark. Electronic address: andjense@rm.dk.
authors.forename: Anders B
authors.initials: AB
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D007182:Income; D016462:Mammaplasty / Q000706:statistics & numerical data*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology
keywords: Breast cancer; Breast reconstruction; Information given; Mastectomy; Socio-demographic factors; Surgery