Health Services Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Cancer. 2014 Oct 1;120(19):3033-9. doi: 10.1002/cncr.28806. Epub 2014 Jun 25.
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.
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.
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.
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.
1998 年至 2008 年期间，美国的乳房切除术后乳房重建手术增加了约 20%，并且已被证明可以改善身体形象、自尊心和生活质量。然而，这些手术在少数民族妇女中较为少见，这可能是由于获得医疗保健的机会不同所致。国防部提供平等的医疗保健机会，从而提供了一个极好的环境，可以评估在获得同等医疗保健的情况下，种族差异是否仍然存在。
使用了国防部癌症登记处和医疗索赔数据的链接。对 1998 年至 2007 年间接受乳房切除术治疗确诊为乳腺癌的白人女性（n = 2974）和黑人女性（n = 708）进行了乳房重建的接受情况进行了比较。
在研究期间，黑人（从 27.3%增加到 40.0%）和白人（从 21.8%增加到 40.6%）乳腺癌女性患者的乳房切除术后重建手术均有所增加。种族之间接受重建手术的情况没有明显差异（优势比，0.93；95%置信区间，0.76-1.15）。重建手术随年龄、肿瘤分期和接受放疗的情况而显著减少，且近年来和现役女性、TRICARE Prime（健康维护组织）受益人和担保人是军官的女性中更为常见。
在这个平等获得医疗保健的体系中，种族之间接受乳房重建手术的情况没有差异，这表明之前的研究报告中存在种族差异，部分原因可能是获得医疗保健的机会不同。进一步研究确定为什么大多数乳腺癌患者不接受重建可能会有所帮助，特别是因为这些手术与非美容相关的益处有关。
