Abstract P4-14-08: Race as an independent factor affecting post-mastectomy reconstruction in Asian women

BACKGROUND: Racial disparities exist in many areas of breast cancer treatment. Multiple factors influence whether Asian women with breast cancer undergo immediate reconstruction after mastectomy. This study aims to evaluate breast reconstruction trends at a comprehensive cancer center and to determine whether race is an independent predictor of breast reconstruction. METHODS: Using an IRB-approved, prospectively maintained database, post-mastectomy reconstruction rates were determined for 2003 to 2013. This database was compiled from three university-affiliated hospitals serving a diverse urban population. A total of 5379 patients were identified who were treated for breast cancer during the 10-year period. The odds-ratio for immediate breast reconstruction was compared among different races. The data was examined to identify factors influencing the decision for post-mastectomy reconstruction, including age, stage of presentation, marital status, and family history of breast cancer. RESULTS: Thirty percent (n=1614) of women treated for breast cancer underwent mastectomy, while seventy percent (n=3765) received breast-conserving therapy. In the mastectomy group, a unilateral procedure was performed in 93.1% (n=1503) of women and a bilateral procedure in 6.9% (n=111). The immediate reconstruction rate after mastectomy was 70% (n=1130), with only 30% (n=484) of women not undergoing reconstruction. Of the women undergoing mastectomy, 58.5% were white, 14.9% were black, 13.1% were Hispanic, 7.5% were Asian and 6% of women did not report race. Of the women who underwent breast reconstruction after mastectomy, 60.5% were white women, 13.4% were black women, 13% were Hispanic women, 6.9% were Asian women and 6.2% of women did not report race. The immediate reconstruction rate by race was 72.2% for white women, 63.2% for black women, 69.8% of Hispanic for women, and 64.8% for Asian women. The remainder did not receive breast reconstruction. The unadjusted odds ratio (OR) for immediate breast reconstruction, including both unilateral and bilateral cases, for black versus white women was 0.62 (95% confidence interval 0.46-0.84; P=0.001). The OR for breast reconstruction for Hispanic versus white women was 0.88 (95% confidence interval; 0.63-1.22; .P=0.45). The OR for unilateral breast reconstruction for Asian versus white women was 0.66 (95% confidence interval 0.44-0.99; P=0.04.) CONCLUSION: Reconstruction rates vary by race, with Asian women being less likely to undergo immediate breast reconstruction after mastectomy. Compared to white women, Asian and black women were both significantly less likely to have immediate breast reconstruction following mastectomy. Many variables may contribute to this disparity in breast cancer care. Language and cultural beliefs may be unique factors that influence Asian women’s decision for post-mastectomy reconstruction and warrant further study. Citation Format: Carmen F Fong, Alyssa Gillego, Theresa Shao, Erika Reategui, Catherine Campo, Sarah Cate, Christopher Mills, Mark L Smith, Gina Aharonoff, Susan K Boolbol. Race as an independent factor affecting post-mastectomy reconstruction in Asian women [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-14-08.