背景:尽管在低至中风险乳腺癌中禁止对侧预防性乳房切除术(CPM)的国家指南,CPM的使用继续上升。乳房重建提高健康相关的生活质量和满意度的妇女接受乳房切除术。鉴于缺乏有关CPM后重建相关因素的数据以及已知的重建益处,我们试图调查CPM后在接受重建方面是否存在差异.
方法:对2004-2017年国家癌症数据库进行了查询,以确定诊断为乳腺癌并接受CPM单侧乳房切除术的女性。患者分为两组:在任何时间点进行计划重建的患者和未进行计划重建的患者。比较重建类型的二次分析(组织,植入物,合并)进行。病人,肿瘤,使用卡方检验分析人口统计学特征,并使用广义估计方程计算比值比。
结果:该队列包括1,73,249名女性:95,818(55.3%)接受了重建,77,431(45.7%)没有接受重建。在2004年至2017年期间,CPM率和CPM后接受重建的妇女比例都有所增加。在重建的妇女中,40,840(51.7%)接受了植入物,29,807(37.7%)有组织,8352(10.6%)进行了合并重建。经过调整后的分析,与重建相关的因素是年轻,西班牙裔种族,私人保险,生活在教育程度和收入中位数最高的地区(P<0.01)。接受重建的患者放疗(P<0.01)和化疗(P<0.01)的可能性较小。更可能患有I期疾病(P<0.01),并在综合癌症中心治疗(P<0.01)。
结论:年轻女性接受CPM后的重建不成比例,西班牙裔,那些有私人保险的人,更高的社会经济地位和教育。虽然CPM后的重建率在增加,仍然存在巨大的差距。必须有意识地努力消除这些差距,特别是考虑到乳房切除术后重建的已知益处。
BACKGROUND: Despite national guidelines against
contralateral prophylactic mastectomy (CPM) in low- to moderate-risk breast cancer, CPM use continues to rise. Breast reconstruction improves health-related quality of life and satisfaction among women undergoing mastectomy. Given the lack of data regarding factors associated with reconstruction after CPM and the known benefits of reconstruction, we sought to investigate whether disparities exist in receipt of reconstruction after CPM.
METHODS: The 2004-2017 National Cancer Database was queried to identify women diagnosed with breast cancer who underwent unilateral mastectomy with CPM. Patients were divided into two groups: those who underwent planned reconstruction at any timepoint and those who did not. A secondary analysis comparing types of reconstruction (tissue, implant, combined) was conducted. Patient, tumor, and demographic characteristics were analyzed using chi-square test and odds ratios were calculated using generalized estimating equations.
RESULTS: The cohort included 1,73,249 women: 95,818 (55.3%) underwent reconstruction and 77,431 (45.7%) did not. Both the rate CPM and the proportion of women undergoing reconstruction after CPM increased between 2004 and 2017. Of the women who had reconstruction, 40,840 (51.7%) received implants, 29,807 (37.7%) had tissue, and 8352 (10.6%) had combined reconstruction. After adjusted analysis, factors associated with reconstruction were young age, Hispanic ethnicity, private insurance, and living in an area with the highest education and median income (P < 0.01). Patients who underwent reconstruction were less likely to have radiation (P < 0.01) and chemotherapy (P < 0.01), more likely to have stage I disease (P < 0.01), and to be treated at an integrated cancer center (P < 0.01).
CONCLUSIONS: Reconstruction after CPM is disproportionately received by younger women, Hispanics, those with private insurance, and higher socioeconomic status and education. While the rate of reconstruction after CPM is increasing, there remain significant disparities. Conscious efforts must be made to eliminate these disparities, especially given the known benefits of reconstruction after mastectomy.