Influence of Facility Characteristics on Breast Reconstruction in Post-Mastectomy Patients with Carcinoma in Situ of the Breast
Daniel Boczar, MD, David J Restrepo, MD, Andrea Sisti, MD, Maria T. Huayllani, MD, Jeremie D. Oliver, BS, BA, Emmanuel Gabriel, MD PhD, Sanjay Bagaria, MD, Sarah McLaughlin, MD PhD, Kris Atwood, Brian D RInker, MD, Antonio Jorge Forte, MD. PhD.
Mayo Clinic Florida, Jacksonville, FL, USA.
Breast reconstructive procedures are a relevant resource of hope for post-mastectomy patients who want to recover their self-esteem and quality of life. We hypothesize that the frequency of post-mastectomy reconstruction is increasing and facilities' characteristics impact in the access to these procedures. We assessed breast reconstruction rates by year and compared facility type, location, and setting between post-mastectomy patients according to the reconstruction modality.
By using the National Cancer Database (NCDB) of breast cancer, we selected patients with carcinoma in situ who underwent mastectomy from 2004 to 2015. Facility type (Community Cancer Program, Comprehensive Community Cancer Program, Academic/Research Program and Other), Facility Location (New England, Middle Atlantic, South Atlantic, East North Central, East South Central, West North Central, West South Central, Mountain, Pacific) and Setting (Metro, Urban, Rural) were summarized by reconstructive modality (No Reconstruction, Autologous, TE, Combined, or NOS) using frequencies and relative frequencies. Our hypotheses were tested using Pearson Chi-square tests with the Holm-Bonferroni method to control the family-wise type I error.
A total of 189,213 patients met the inclusion criteria. The overal rate of "no reconstruction" was 70.2% and it steadily decreased from 2004-2007 (n=17594, 82%) to 2013-2015 (n=39588, 63.7%)(p<0.001). Compared to the overall, we noticed a lower proportion of "no reconstruction" in Academic/Research Programs (n=34899, 62.9%) and metropolitan area (n=68.4%) (p<0.001). On the contrary, the regions of East South Central (n=11,072, 77.0%) and Pacific (n=17,388, 74.2%) had a higher proportion of "no reconstruction" (p<0.001).
Although this study was able to demonstrate a reduction of "no reconstruction" over the years, we also found disparities regarding facility characteristic.
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