A School of Public Health study found health insurance coverage and racial disparities exist in women who have undergone reconstruction after mastectomy. In 2013, more than 232,000 women were diagnosed with breast cancer in the United States, and 37 percent of those women with breast cancer underwent a mastectomy, or the surgical removal of breast tissue. Of those, nearly one third undergo breast reconstruction to rebuild the shape of the removed breast. Breast reconstruction after mastectomy offers clinical, cosmetic and psychological benefits with low medical risk.

Study findings were recently published in Women’s Health Issues.

“After analyzing the data, the differences by health insurance coverage and racial disparities in rates of reconstruction were startling,” said Tetyana Shippee, Ph.D., lead author of the study and assistant professor in the School of Public Health. “Generally, insurance type shouldn’t be a huge part of the reconstruction decision-making process. This used to be the case, but in 1998, Congress passed the Women’s Health and Cancer Rights Act. Under the Act, group health plans, insurance companies, and HMOs that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy. Also, since the 2000s, most states passed laws that require federal and publicly funded state programs providing coverage for mastectomy surgery to also provide coverage for reconstruction of the breast (including surgeries not covered under the Women’s Health Act).”

Despite new health policies to expand access, study findings show that insurance type played a significant role in whether women received reconstruction. However, access to health insurance did not fully account for the notable racial/ethnic disparities in care.

Minority women were much less likely to undergo reconstruction in comparison to their White counterparts.

Additional study findings include:

• The proportion of women with private health insurance coverage who received reconstruction was more than twice as high as those with public coverage or no insurance.
• Among women with public coverage, African-American and Asian women had lower odds of receiving reconstruction compared to Caucasian women (64 percent and 35 percent of the odds for White women, respectively).
• Among women with private coverage, African-American, Hispanic and Asian women had lower odds of receiving reconstruction compared to Caucasian women (44 percent, 69 percent, and 54 percent respectively of the odds for White women).
• Among the uninsured, the odds of reconstruction did not significantly vary by race/ethnicity.
• For all racial and ethnic groups, women with public coverage had a lower probability of reconstruction than privately insured women (16.8-31.0 percent vs. 36.4-56.1 percent, respectively).
• Regardless of insurance type, Asian women were least likely to have reconstruction in this scenario.

Shippee believes that health care providers and health insurance companies can help their patients by making them more aware of the benefits reconstruction after mastectomy can provide. Communicating the option is an available option with expanded coverage under the Affordable Care Act is also important. Yet, involvement is also needed from culturally relevant advocacy organizations, coupled with help from patient navigators or others who can facilitate access and decision-making. Finally, greater patient involvement in the decision-making process is another important component of raising awareness of the procedure.

“For minority groups especially, it’s important to have a conversation with your health care provider to learn more about reconstruction after mastectomy. If reconstruction is right for them, it could be an empowering and transformational procedure,” Shippee said.

Shippee adds that further research is needed to understand the decision-making process that women with mastectomy go through. This includes examining patient preferences and how they are influenced by economic factors, patients’ network and community, and interactions with physicians.

~ Post by Matt DePoint, Academic Health Center