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Race and Socioeconomic Status in Breast Reconstruction after Prophylactic Mastectomy
Nicolás Kass, Eva Roy, Elizabeth A. Moroni, Angela Prescott, Carolyn De La Cruz
University of Pittsburgh School of Medicine
2022-01-15
Presenter: Nicolás Kass
Affidavit:
The majority of the work on this project represents the original work of the presenting medical student, Nicolás Kass
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: The objective of this study was to evaluate the influence of race and socioeconomic status on the decision to undergo risk-reduction mastectomy and reconstruction in patients with known genetic predisposition for breast cancer.
Methods: Under IRB approval, electronic medical records of patients with genetic predisposition for breast cancer who underwent risk-reduction mastectomy and reconstruction by the senior author (between 2007 and 2020) were merged with the Agency for Healthcare and Research Quality's (AHRQ) Social Determinants of Health Database and retrospectively reviewed.
Results: 64 patients were included in the analysis. Majority were Caucasian/ non-Hispanic (96.61%), and (95%) came from ZIP codes where more than 75% of the population was Caucasian. The median household income in our patients' ZIP codes was $63,567; SD $21,111 (national mean=$50,791, SD $14,455). The median home value in these areas was $163,358, SD $79,710 (national mean=$146,127, SD 89, 409). Majority of patients live in an urban environment (86.67%), followed by suburban (10%) and rural (3.34%) environments. Most patients came from ZIP codes with higher levels of private health insurance and lower levels of public health insurance (private mean 69.8%; SD 10.84, public mean=18.5%, SD 8.1) compared to national averages (private mean=60.5%, SD 12.38, public mean=26.2%, SD 9.87).
Conclusion: This study revealed that white women living in predominantly white, higher-income neighborhoods make up the overwhelming majority of our patient cohort which underwent risk-reduction mastectomy and breast reconstruction. This highlights a need to improve access to life-improving reconstructive surgery in lower income and non-white populations.
