术后乳房重建中种族差异的减少：1998 年至 2014 年的监测、流行病学和最终结果分析。
Decline in Racial Disparities in Postmastectomy Breast Reconstruction: A Surveillance, Epidemiology, and End Results Analysis from 1998 to 2014.
机构信息
From the Division of Plastic, Maxillofacial, and Oral Surgery and the Department of Surgery, Duke University Medical Center; and the Department of Biostatistics and Bioinformatics, Duke Cancer Institute.
出版信息
Plast Reconstr Surg. 2019 Jun;143(6):1560-1570. doi: 10.1097/PRS.0000000000005611.
BACKGROUND
Despite increasing emphasis on reducing racial disparities in breast cancer care in the United States, it remains unknown whether access to breast reconstruction has improved over time. The authors characterized contemporary patterns of breast reconstruction by race and ethnicity.
METHODS
The Surveillance, Epidemiology, and End Results database was used to identify women undergoing mastectomy for stage 0 to III breast cancer from 1998 to 2014. Multivariable logistic regression was used to estimate the association of demographic factors with likelihood of postmastectomy reconstruction. Multivariable logistic regression was used to predict reconstruction subtype. Patients undergoing reconstruction were grouped by diagnosis year to assess change in the population over time by race and ethnicity.
RESULTS
Of 346,418 patients, 21.8 percent underwent immediate reconstruction. Non-Hispanic black race (OR, 0.71) and Hispanic ethnicity (OR, 0.63) were associated with a decreased likelihood of reconstruction (all p < 0.001). Race was predictive of reconstruction type, with non-Hispanic black (OR, 1.52) and Hispanic women (OR, 1.22) more likely to undergo autologous versus implant-based reconstruction (p < 0.001). Although rates of reconstruction increased over time across all races, non-Hispanic black and Hispanic patients had a higher adjusted per-year increase in rate of reconstruction compared with non-Hispanic white patients (interaction p < 0.001).
CONCLUSIONS
Rates of postmastectomy reconstruction have increased more quickly over time for minority women compared with white women, suggesting that racial disparities in breast reconstruction may be improving. However, race continues to be associated with differences in types and rates of reconstruction. Further research is necessary to continue to improve access to breast reconstruction in the United States.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
背景
尽管美国越来越重视减少乳腺癌治疗中的种族差异，但仍不清楚接受乳房重建的机会是否随着时间的推移而有所改善。作者根据种族和民族特征描述了当代乳房重建的模式。
方法
利用监测、流行病学和最终结果数据库，从 1998 年至 2014 年，确定接受保乳手术治疗 0 期至 3 期乳腺癌的女性。多变量逻辑回归用于估计人口统计学因素与乳房切除术后重建可能性之间的关系。多变量逻辑回归用于预测重建亚型。根据诊断年份对接受重建的患者进行分组，以评估不同种族和民族的人群随时间的变化情况。
结果
在 346418 名患者中，21.8%接受了即刻重建。非西班牙裔黑人种族（OR=0.71）和西班牙裔（OR=0.63）与重建可能性降低相关（均 p<0.001）。种族可预测重建类型，非西班牙裔黑人（OR=1.52）和西班牙裔女性（OR=1.22）更可能接受自体与基于植入物的重建（p<0.001）。尽管所有种族的重建率都随着时间的推移而增加，但与非西班牙裔白人患者相比，非西班牙裔黑人和西班牙裔患者的重建率调整后每年增加率更高（交互作用 p<0.001）。
结论
与白人女性相比，少数民族女性乳房切除术后重建的比例随着时间的推移增加得更快，这表明乳房重建中的种族差异可能正在改善。然而，种族仍然与重建类型和比例的差异有关。需要进一步研究，以继续改善美国接受乳房重建的机会。
临床问题/证据水平：风险，III。
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