Comparing Surgical Management and Reconstruction of Breast Cancer Patients at a Tertiary Care Center and an Associated Safety-Net Institution

Abstract

Purpose

This study aimed to assess the rates of breast conservation therapy and mastectomy with and without immediate postmastectomy reconstruction (IPMR) amongst racially distinct subgroups being treated with neoadjuvant chemotherapy (NAC).

Methods

Women who received NAC for newly diagnosed breast cancer from 2010 to 2017 were identified from an institutional tumor registry at a tertiary care center and an associated safety-net institution. Patient demographics, insurance status, tumor characteristics, and surgical procedures were compared after women were stratified by race.

Results

At the tertiary care facility, a higher proportion of White women were treated with bilateral mastectomy (35.7%) compared to Black (19.3%) and Hispanic women (9.8%). White women were also more likely to receive IPMR as compared to Black and Hispanic women (63.7% vs. 42.7% and 33.3% respectively). At the associated safety-net institution, women were more likely to undergo a unilateral mastectomy, regardless of race, and there was no statistical difference in the rates of IPMR amongst the different racial cohorts (17.2%-18.7%). IPMR was performed in 52.4% of cases at the tertiary care center compared to 18.2% at the safety-net institution.

Conclusion

Despite controlling for confounding factors, disparities exist in the treatment of breast cancer patients. This study focuses on differing rates of mastectomy and IPMR when comparing an associated tertiary care center and safety-net institution. The discrepancy is profound and appears to be driven by race, insurance, and institution type.