Investigating disparities in breast reconstruction rates after mastectomies

Yale Cancer Center researchers at Yale School of Medicine found significant disparities in the use of post-mastectomy immediate breast reconstruction (PMIBR) among elderly women, especially in the United States and also in South Korea.

The researchers presented their findings at the San Antonio Breast Cancer Symposium (SABCS) on December 6. The study analyzed trends in PMIBR across age groups by decade of life between 2001 and 2021 and compared the findings among Americans, Asian Americans, and South Koreans with data from the National Cancer Database (NCDB) in the United States and from Asan Medical Center in South Korea.

"Post-mastectomy reconstruction could be a safe and viable option for the aging population, and we have to rethink that paradigm," said Tristen Park, MD, a co-senior author of the study and member of Yale Cancer Center. "We should also start thinking about the forms of disparities of care that exist for Asian Americans in America. I think this study presents some interesting questions."

Researchers found that the PMIBR rate at a large South Korean medical center increased almost tenfold over 20 years with a notable discrepancy between women under the age of 60 and women over 60. In the younger age group, PMIBR rates rose from 13% to 77%. While in the older group, it increased only from 0% to 26%.

In the U.S., Asian Americans had the lowest rate of breast reconstruction (29%) compared to other racial groups. Soo Young Lee, MD, first author of the study noted that the Korean data included peri-operative complication rates, which were similar between older and younger women.

"What I considered very striking was that the rates of post-mastectomy reconstruction in Asian Americans was much lower than non-Asian Americans," said Dr. Park, who is also an assistant professor of Surgery (breast oncology) at Yale School of Medicine. "And so, one would think that in Asia post rates of post-mastectomy reconstruction would also be low, but in fact, they're much higher."

Researchers note that both the South Korean and American data illustrate remarkably lower use of immediate breast reconstruction in older patients. There were some notable demographic and clinical differences between age groups, but negligible differences in complication rates. Further research and interventions to address barriers in older women are needed.

Finally, the higher rates of PMIBR in South Korea mirrors that of white women in the U.S. northeast, suggesting a potential disparity for Asian American women.

Madhav KC, Leah Kim, Mehra Golshan, Eric Schneider, Rachel Greenup, and Donald Lannin all were Yale co-authors on the study. Hee Jeong Kim MD, Ph.D., professor of surgery from Asan Medical Center was a co-senior author.