San
Antonio Breast Cancer Symposium
SAN ANTONIO — Having health insurance was linked to an increased
likelihood of undergoing breast reconstruction after mastectomy, according to
findings presented here.
Dawn L. Hershman, MD,of the departments of medicine and
epidemiology at Columbia University in New York, said the aim of the study was
to determine factors that influenced the decision to undergo post-mastectomy
reconstructive surgery.
“Immediate reconstructive surgery is associated with improved
psychological health, self-esteem and body image,” Hershman said.
The researchers evaluated demographic-, hospital-, physician- and
insurance-related factors in the decision to have immediate breast
reconstruction.
Data for ICD-9 procedure codes for 108,992 women who underwent
mastectomy for invasive breast cancer and 14,710 women with ductal carcinoma in
situ from 2000 to 2010 were pulled from a database that includes 500 acute care
hospitals in the United States.
“Health insurance carriers that cover mastectomy also should cover
reconstruction,” Hershman said.
The final analysis showed that 23.4% of the women who had invasive
cancer underwent immediate reconstruction, and for women with ductal carcinoma
in situ, it was 36.4%. The reconstruction rate increased from 15% in 2000 to
33.3% in 2010. The largest increases were observed in women who had commercial
insurance (25.3% to 54.6%) and women aged younger than 50 years (29% to 60%).
The reconstructive surgery rate was 67.5% among women aged younger than 50
years with commercial insurance in 2010.
Multivariate analysis results indicated that the following factors were
linked to a decreased likelihood of reconstruction:
- Increasing age.
- Black race (OR=0.66).
- Rural hospital location (OR=0.48).
- Non-teaching hospital (OR=0.82).
- More than two comorbid conditions (OR=0.72).
“Caucasian women had higher rates of reconstruction than
African-American women,” Hershman said.
Factors associated with increased odds of reconstructive surgery
included commercial (OR=2.7) and public (OR=1.6) insurance (compared with
self-pay), bilateral mastectomies (OR=2.5), being single (OR=1.09) and
increased hospital mastectomy volume (OR=1.94).
“The influence of insurance coverage on immediate reconstruction
rates has increased over time, while the cost has almost tripled over the
10-year period,” she said.
There was a small link between reconstruction and breast surgeon volume.
Similar associations were seen in the subgroup of women aged younger than 50
years, according to the results.
“Prolonged length of stay was greater for women undergoing
reconstruction (3.5 days vs. 1.6 days),” the researchers wrote. However,
in-hospital complication rates were similar between the two groups.
“Public policy should ensure that access to reconstructive surgery
is available to all women, regardless of insurance type,” Hershman said.
Earn CME this spring at the HemOnc Today Breast Cancer Review & Perspective meeting to be held March 23-24, 2012 at the Hilton San Diego Bayfront. See details at HemOncTodayBreastCancer.com.
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Patricia
Ganz
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Many women are reluctant to undergo a second operation for
reconstruction. However, if it is possible to offer mastectomy and
reconstruction simultaneously, that is appealing to women. Women in urban areas
or higher volume may be more likely to have a surgeon available to handle the
cosmetic surgery immediately. It is an access issue, but, in this case, we are
talking about access in terms of availability of surgery combined with
insurance coverage.
Having lived through the time when there was no reconstruction offered,
even if women don’t want it, it is important that there is a discussion,
and that the surgery is offered. What we are seeing is a disparity in what is
offered.
Patricia Ganz, MD
Jonsson Comprehensive Cancer Center at the University
of California at Los Angeles
For more information:
- Hershman D. #S6-3. Presented at: 2011 CTRC-AACR San Antonio Breast
Cancer Symposium; Dec. 6-10, 2011; San Antonio.