Increases in Postmastectomy Reconstruction in New York State Are Not Related to Changes in State Law.
Adult
Aged
Breast Neoplasms
/ pathology
Chi-Square Distribution
Databases, Factual
Female
Health Policy
/ legislation & jurisprudence
Humans
Incidence
Logistic Models
Mammaplasty
/ legislation & jurisprudence
Mastectomy
/ methods
Middle Aged
Multivariate Analysis
New York
Policy Making
Postoperative Period
Retrospective Studies
Risk Assessment
Socioeconomic Factors
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
entrez:
27
7
2019
pubmed:
28
7
2019
medline:
16
11
2019
Statut:
ppublish
Résumé
Postmastectomy reconstruction remains underused. In 2011, new legislation in New York State mandated discussion of reconstructive options before mastectomy. This study assesses the impact of this policy on immediate breast reconstruction rates. The Statewide Planning and Research Cooperative System database was queried to identify women undergoing mastectomy from January of 2005 to October of 2015 and follow them for at least 1 year postoperatively to determine the incidence and timing of reconstruction. Demographic and socioeconomic characteristics were collected. Chi-square test and multivariable logistic regression were used to compare periods before (2005 to 2010) and after (2011 to 2015) the legislative change. Of 52,837 records, there were 24,340 patients (46 percent) who underwent immediate breast reconstruction. The incidence of immediate breast reconstruction increased over the study period, most significantly in 2008 to 2009. Rates of immediate breast reconstruction continued to increase, although at a slower rate, after 2011 compared with before 2011 across all subgroups. Both implant and autologous reconstructive techniques increased over time. Implant-based reconstruction increased steadily, whereas autologous reconstruction increased most significantly between 2008 and 2009. Despite an overall increase in immediate breast reconstruction, there was an overall lack of effect on post-2011 reconstructive rates attributable to the legislative changes. Reconstructive rates have increased significantly in New York State over the past decade, and these changes appear to be largely independent of the 2011 New York State Breast Reconstruction Act. There are likely nonlegislative drivers of breast reconstruction use.
Sections du résumé
BACKGROUND
Postmastectomy reconstruction remains underused. In 2011, new legislation in New York State mandated discussion of reconstructive options before mastectomy. This study assesses the impact of this policy on immediate breast reconstruction rates.
METHODS
The Statewide Planning and Research Cooperative System database was queried to identify women undergoing mastectomy from January of 2005 to October of 2015 and follow them for at least 1 year postoperatively to determine the incidence and timing of reconstruction. Demographic and socioeconomic characteristics were collected. Chi-square test and multivariable logistic regression were used to compare periods before (2005 to 2010) and after (2011 to 2015) the legislative change.
RESULTS
Of 52,837 records, there were 24,340 patients (46 percent) who underwent immediate breast reconstruction. The incidence of immediate breast reconstruction increased over the study period, most significantly in 2008 to 2009. Rates of immediate breast reconstruction continued to increase, although at a slower rate, after 2011 compared with before 2011 across all subgroups. Both implant and autologous reconstructive techniques increased over time. Implant-based reconstruction increased steadily, whereas autologous reconstruction increased most significantly between 2008 and 2009.
CONCLUSIONS
Despite an overall increase in immediate breast reconstruction, there was an overall lack of effect on post-2011 reconstructive rates attributable to the legislative changes. Reconstructive rates have increased significantly in New York State over the past decade, and these changes appear to be largely independent of the 2011 New York State Breast Reconstruction Act. There are likely nonlegislative drivers of breast reconstruction use.
Identifiants
pubmed: 31348328
doi: 10.1097/PRS.0000000000005794
pii: 00006534-201908000-00004
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
159e-166eCommentaires et corrections
Type : CommentIn
Références
Tseng JF, Kronowitz SJ, Sun CC, et al. The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer. Cancer 2004;101:1514–1523.
Sisco M, Du H, Warner JP, Howard MA, Winchester DP, Yao K. Have we expanded the equitable delivery of postmastectomy breast reconstruction in the new millennium? Evidence from the national cancer data base. J Am Coll Surg. 2012;215:658–666; discussion 666.
Albornoz CR, Bach PB, Pusic AL, et al. The influence of sociodemographic factors and hospital characteristics on the method of breast reconstruction, including microsurgery: A U.S. population-based study. Plast Reconstr Surg. 2012;129:1071–1079.
Kruper L, Holt A, Xu XX, et al. Disparities in reconstruction rates after mastectomy: Patterns of care and factors associated with the use of breast reconstruction in Southern California. Ann Surg Oncol. 2011;18:2158–2165.
Giladi AM, Aliu O, Chung KC. The effect of medicaid expansion in New York State on use of subspecialty surgical procedures by medicaid beneficiaries and the uninsured. J Am Coll Surg. 2014;218:889–897.
Iskandar ME, Dayan E, Lucido D, et al. Factors influencing incidence and type of postmastectomy breast reconstruction in an urban multidisciplinary cancer center. Plast Reconstr Surg. 2015;135:270e–276e.
Yang RL, Newman AS, Lin IC, et al. Trends in immediate breast reconstruction across insurance groups after enactment of breast cancer legislation. Cancer 2013;119:2462–2468.
Farhangkhoee H, Matros E, Disa J. Trends and concepts in post-mastectomy breast reconstruction. J Surg Oncol. 2016;113:891–894.
Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in U.S. breast reconstruction: Increasing implant rates. Plast Reconstr Surg. 2013;131:15–23.
Jagsi R, Li Y, Morrow M, et al. Patient-reported quality of life and satisfaction with cosmetic outcomes after breast conservation and mastectomy with and without reconstruction: Results of a survey of breast cancer survivors. Ann Surg. 2015;261:1198–1206.
Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;32:919–926.
Alderman AK, Hawley ST, Waljee J, Mujahid M, Morrow M, Katz SJ. Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer. Cancer 2008;112:489–494.
Alderman AK, Hawley ST, Morrow M, et al. Receipt of delayed breast reconstruction after mastectomy: Do women revisit the decision? Ann Surg Oncol. 2011;18:1748–1756.
Morrow M, Mujahid M, Lantz PM, et al. Correlates of breast reconstruction: Results from a population-based study. Cancer 2005;104:2340–2346.
Albornoz CR, Cordeiro PG, Pusic AL, et al. Diminishing relative contraindications for immediate breast reconstruction: A multicenter study. J Am Coll Surg. 2014;219:788–795.
Hartocollis A. Before breast is removed, a reconstruction discussion. The New York Times. August 19, 2010:A23.
Bakalar N. Treatments: Talking out the choices for breast cancer surgery. The New York Times. December 26, 2007:F6.
Singer N. Some hidden choices in breast reconstruction. The New York Times. December 22, 2008:A1.
Desai S, Jena AB. Do celebrity endorsements matter? Observational study of BRCA gene testing and mastectomy rates after Angelina Jolie’s New York Times editorial. BMJ 2016;355:i6357.