African American Women More Likely to Choose Autologous Breast Reconstruction Over Implant-Based Reconstruction
African American women undergoing mastectomy for breast cancer are more likely than white women to undergo autologous breast reconstruction using their own tissue, rather than implant-based reconstruction, reported Sharma et al in Plastic and Reconstructive Surgery.
“African American race remains the most clinically significant predictor of choice of autologous-based breast reconstruction, even after accounting for other important characteristics,” according to Terence Myckatyn, MD, Ketan Sharma, MD, MPH, and colleagues at Washington University School of Medicine, St. Louis. While further studies are needed, the researchers suggested the difference might reflect patient preferences.
Twofold Increase in Autologous Reconstruction
The researchers analyzed data on more than 2,500 women undergoing either autologous or implant-based breast reconstruction after mastectomy. Fourteen percent of the women were African American, and 82% were Caucasian.
Overall, 18% of women underwent autologous breast reconstruction. In most of the remaining women, breast reconstruction was done using implants.
African American women had a higher rate of autologous breast reconstruction: 23%, compared to 17% of white women. The two groups differed in some key characteristics: African American women were more likely to have Medicaid insurance coverage and live in a low-income area; they also had higher rates of smoking, obesity, and diabetes.
On analysis adjusting for all of these differences, African American race was still significantly associated with autologous reconstruction. African American women were about twice as likely to choose autologous reconstruction, independent of other factors.
Study Implications
Racial disparities have been found in many areas of health care, including plastic and reconstructive surgery. “Since the breast represents a symbol of femininity, breast reconstruction is critical to mitigating the psychosocial stigma of a breast cancer diagnosis,” Drs. Myckatyn, Sharma, and coauthors wrote.
Based on controlled analysis in a large sample, the results strongly suggest that African American race predicts a higher rate of autologous breast reconstruction. While the study can't determine the reasons for this racial difference, other evidence suggests that access to care is not the sole cause.
Based on his experience at a large referral center, Dr. Myckatyn believes that “patient-based factors” are the main contributor to the difference. It may be that African American women prefer to undergo reconstruction using their own tissue rather than “foreign” implants. They may also prefer autologous reconstruction, usually performed immediately after mastectomy, over two-stage reconstruction using implants.
Dr. Myckatyn emphasizes the need for further research to confirm the higher rate of autologous breast reconstruction in African American women, and to evaluate potential reasons for the discrepancy. He added. “If the difference is related to system-based rather than patient-based factors, interventions may be needed to alleviate racial disparities in breast reconstruction.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
