African-American women are less likely to be treated with breast reconstruction after mastectomy than women of other races, independent of age and clinical and socioeconomic factors. According to a new study published August 23, 2004 in the online edition of CANCER, a peer-reviewed journal of the American Cancer Society, African-American women had significantly lower immediate breast reconstruction rates compared to Caucasian, Asian, and Hispanic women. The abstract of this article will be freely accessible via the CANCER Newsroom (http://www.interscience.wiley.com/cancer-newsroom) upon online publication.
Race has been demonstrated to be a significant independent risk factor in the clinical course of many diseases, including breast cancer and lung cancer. Its role is complex and may directly affect tumor behavior through genetic factors, lack of access to healthcare, and treatment patterns. Few studies have examined the impact of race on patient care by examining specific physician-patient interactions. Moreover, few studies have characterized treatment differences in Hispanic, Middle Eastern, and Asian women.
Henry M. Kuerer, M.D., Ph.D., from the University of Texas M. D. Anderson Cancer Center and his colleagues reviewed data from 1004 patients with primary breast cancer treated with mastectomy. They investigated what role if any race plays in predicting immediate or delayed breast reconstruction.
Women who elect mastectomy to treat breast cancer have to decide whether to undergo immediate breast reconstruction at the time of mastectomy, or delay breast reconstruction for months to years to complete adjuvant therapy, or not have breast reconstruction at all. However, previous investigators have found that women who elect immediatebreast reconstruction have greater improvement in quality of life compared to women who undergo delayed reconstruction.
In the current study, the University of Texas M.D. Anderson investigators found that race independently predicted the likelihood that patients would undergo immediate breast reconstruction. When compared to Caucasians, Hispanics, and Asian women, African-American women underwent significantly less immediate breast reconstruction. In addition, the rate of delayed breast reconstruction was also lower in African-Americans and Asians than in Caucasians. Middle Eastern women also had significantly lower rates of immediate reconstruction but higher rates of delayed reconstruction, compared to Caucasians. Hispanic and Middle Eastern women showed no significant differences in their rates of breast reconstruction than Caucasian women.
Analysis of the steps to immediate breast reconstruction demonstrated that the surgical oncologist, patient, and plastic surgeon may all contribute to the overall difference. The reasons for these racial discrepancies demonstrated that physicians were less likely to offer referrals for breast reconstruction or recommend reconstruction to African-American women. In addition, African-American women were less likely to accept a referral for breast reconstruction or accept the surgeon's recommendation for breast reconstruction. The factors that contribute to these differences appear multi-factorial and warrant further study.
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