Examining a Decade of Racial Disparity in Partial Mastectomy and Oncoplastic Surgery
Michael M. Jonczyk, MD, MS1,2, Jolie Jean, MD2, Christopher Homsy, MD2, Stephen Naber, MD, PhD3, Abhishek Chatterjee, MD, MBA2
1Department of Surgery, Lahey Hospital & Medical Center, Burlington, MA; 2Department of Surgery, Tufts Medical Center, Boston, MA; 3Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston MA
BACKGROUND: Understanding racial disparity is crucial to addressing health equity and access to care. No previous studies have analyzed these disparities in breast conserving surgery (BCS) subgroups: partial mastectomy and oncoplastic surgery. Therefore, our study aims to examine racial differences in BCS utilization rates within an 11-year period to determine how these rates have changed over time.
METHODS: This retrospective cohort analysis utilized the NSQIP database to identify women who underwent BCS procedures diagnosed with either DCIS or invasive breast cancer. BCS was further sub-divided into subgroups. Patient demographics were recorded, and racial utilization trends were analyzed using a Cochran- Armitage test and Index of Disparity analysis.
RESULTS: In the 11-year period, 180,700 women underwent a breast cancer resection. From 2008 to 2018 BCS utilization increased from 38% to 53%. Within the BCS subgroup, the proportion of patients having oncoplastics increased from 3% to 10%, leading to a declining proportion of partial mastectomies: 97% to 90.0% (all p<0.01). When stratified by race, oncoplastic utilization between increased from 4% to 10% in Asian and Caucasian patients, and 1% to 10% in African American patients (p<0.01). Overall, the racial index of disparity for BCS patients decreased from 7% to 5%. Interestingly, the index of disparity has remained unchanged (1%) for partial mastectomies, but significantly decreased in oncoplastics (23% to 8%) suggesting an improvement in racial disparities for this surgical option.
CONCLUSION: As BCS represents a mainstay option for early-staged breast cancer interventions, it is crucial to study the potential for persistent racial inequalities in minority populations receiving these options. This study demonstrates promising progress within the field of breast conservation surgery with a decreasing index of disparity among races.
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