MONDAY, Nov. 17, 2008 (HealthDay News) -- After a mastectomy, wealthier women are more likely to have immediate breast reconstruction than their poorer counterparts, Johns Hopkins University researchers report.
This is also true for more educated women and women who don't live in inner cities. Overall, black women and those who live in predominantly black neighborhoods are less likely to undergo breast reconstruction.
"The community a patient lives in actually does influence, in some way, the access they have to breast reconstruction," said lead researcher Dr. Gedge D. Rosson, an assistant professor of plastic surgery. "We need to learn more about why that is."
Rosson isn't sure why these disparities exist. "There must be bias in some way," he said.
"People have noticed that African-Americans have fewer referrals to plastic surgeons, and if they do have a referral, they have a lower rate of going to those referrals," Rosson said. "Strangely, even once they see the plastic surgeon, reconstruction seems to be offered with less frequency."
Another reason these women may not opt for breast reconstruction is the belief that it is cosmetic surgery, Rosson said. "Maybe they have an unconscious aversion to it or something like that," he said.
Rosson noted that this is a community effect, so that even a white patient living in a poor black neighborhood is less likely to undergo immediate breast reconstruction.
The report is published in the November issue of the Archives of Surgery.
For the study, Rosson's team collected data on 17,925 black and white women who had a mastectomy between 1995 and 2004. The researchers also analyzed data of the communities the women lived in. Among these women, 27.9 percent had breast reconstruction immediately after their mastectomy.
The researchers found that black women were 47 percent less likely to have breast reconstruction. Other factors that signaled not undergoing breast reconstruction were being older, living in inner cities with a high black population, and having a high school education or less.
Rosson's group noted that having breast reconstruction immediately after mastectomy has several advantages including aesthetics, psychosocial well-being and cost-effectiveness.
The researchers think educational programs should be developed to let these women know the benefits of breast reconstruction.
"Prospective public health measures, including educational and informative programs, can be developed and implemented in the community to address these inequalities [particularly racial/ethnic disparities based on neighborhood] and to increase the likelihood that patients with breast cancer and mastectomy obtain immediate reconstruction," the researchers concluded.
Brenda Salgado, program manager at Breast Cancer Action in San Francisco, thinks that both minority women and the medical community contribute to the differences seen in breast reconstruction.
"Women choose not to have reconstruction for a number of reasons," Salgado said. "It may have to do not just with access to providers and insurance, it may have to do with mistrust of the medical industry and concern about implants."
Black and Asian women are more likely to develop unattractive scaring and even autoimmune disease from implants, Salgado said.
Cultural preferences may also play a role in the decision whether or not to undergo breast reconstruction, Salgado said. "Some women may not feel the need to do the reconstruction as much as other women. We need to think about cultural issues like body image and reconstruction. And that may be different in different communities," she said.
To make an informed decision, women need to know all the options, Salgado said. "Not just that breast reconstruction is available, but also the pros and cons," she said. "There needs to be unbiased education that is not controlled by the industry that would profit from more breast reconstructions."
For more about breast cancer, visit the American Cancer Society.