Vangsness Kella L, Cornely Ronald M, Sam Andre-Philippe, Munabi Naikhoba C O, Chu Michael, Agko Mouchammed, Chang Jeff, Carre Antoine L
Community Memorial Hospital System, Ventura, CA 93036, USA.
Emory University, Atlanta, GA 30322, USA.
Cancers (Basel). 2025 Jun 16;17(12):2002. doi: 10.3390/cancers17122002.
Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care.
The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013-2021 and 2000-2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson's chi-square analysis was performed.
We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40-49 age group received significantly less MO (38.1%) compared to the 70-74 age group (94.8%, ( = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions ( = <0.001).
Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care.
乳房切除术后进行乳房重建可改善生活质量和心理社会结局，然而尽管有多项联邦规定，乳房重建手术的实施仍不连贯。目前的数据显示，少数族裔、社会经济地位较低者以及拥有公共医疗保险者的乳房重建率较低。许多障碍仍未被充分理解或研究。本研究旨在探讨乳房切除术后乳房重建的障碍，通过解决公平获得护理的多因素障碍来营造支持性的临床环境。
本回顾性观察研究使用了加利福尼亚癌症登记处数据监测、流行病学和最终结果（SEER）数据库以及加利福尼亚卫生与公众服务局癌症手术数据库（分别为2013 - 2021年和2000 - 2021年），以研究乳房切除即刻乳房重建（IBR）、延迟乳房重建（DBR）或仅乳房切除（MO）的比率。收集了年龄、性别、种族、保险类型、医院类型、社会经济地位和居住地址等数据。进行了Pearson卡方分析。
我们发现共进行了168,494例乳房切除和重建手术（82.36%为MO，7%为IBR，10.6%为DBR）。40 - 49岁年龄组接受MO的比例（38.1%）显著低于70 - 74岁年龄组（94.8%，P<0.001）。拥有私人保险、健康维护组织（HMO）或优先提供者组织（PPO）保险的患者进行重建手术的比例显著更高（IBR为75.86%，DBR为75.32%，P<0.001）。几乎所有乳房手术都在城市地区进行，而非农村/偏远农村地区（96.02%对1.55%，P<0.001）。不同种族之间没有显著差异。在所有手术中，7.46%在癌症中心完成，其中IBR的比例显著更高。洛杉矶县、圣路易斯奥比斯波/文图拉县和北加利福尼亚州的MO手术比其他地区显著更多（P<0.001）。
乳房切除术后的重建率较低，只有17.64%的患者接受了重建手术。在全国范围内，70.5%的患者接受了MO手术，29.6%的患者接受了重建手术。对重建有积极影响的显著因素包括私人保险、高社会经济地位、癌症中心护理和城市居住。已确定的障碍包括公共医疗保险参保、农村或非城市居住、年龄较大、社会经济地位较低以及非白人种族/族裔，这表明可能存在对护理的经济影响。
