American Indian/Alaska Native Breast Cancer Patients Less Likely to Get Reconstruction

2024-07-08

MONDAY, July 8, 2024 — After a mastectomy, some women are less likely than others to have breast reconstruction surgery.

Rates of the surgery are consistently lower among American Indian and Alaskan native women than among non-Hispanic white women, according to a new study that pointed to age, stage of cancer and insurance as contributors.

"Despite an upward trend in reconstruction, [American Indian/Alaska Native] women continue to be less likely to undergo breast reconstruction," said study co-author Dr. Jane Hui, of the University of Minnesota. "While our findings point to some possible approaches to reducing this disparity, it will be essential to also determine Native women's opinions related to breast reconstruction."

For some women, breast reconstruction after mastectomy helps with body image and quality of life. The decision is a personal one, researchers said, adding "there is no optimal proportion of patients" who should choose reconstruction.

The findings -- published in the July issue of Plastic and Reconstructive Surgery -- stem from a review of data from more than 416,000 women with breast cancer who had mastectomies between 2004 and 2017.

Breast reconstruction rates and factors contributing to decisions about reconstruction surgery were examined.

Researchers found that the American Indian/Alaska Native women differed from their non-Hispanic white counterparts in several respects.

They had more often had additional medical problems (20% versus 12%); were more likely to have government health insurance (49% versus 20%); and were more likely to have had one breast removed, not two.

Over the 13-year study period, an increasing percentage in both groups opted for breast reconstruction. Among American Indian/Alaska Native women, 47% had reconstruction in 2017, compared to 13% in 2004.

Among the white women, the percentages jumped from 29% to 62%.

Factors linked to lower reconstruction rates included older age, public insurance and lower education. Rates were also lower among women who were diagnosed in earlier years of the study and those who had one breast removed.

American Indian/Alaska Native women face a variety of health disparities, including higher rates of chronic conditions, later diagnosis and higher rates of death from breast cancer, the study noted.

Contributing to the issue is what researchers described as "chronic underfunding of the Indian Health Service," bias among women in the two groups and "fraught relationships" between them and doctors.

"Multidisciplinary efforts to improve care deliver to [American Indian/Alaska Native] women may continue to minimize disparities through earlier diagnosis and treatment," the researchers said in a journal news release.

At the same time, researched aimed at understanding perspectives in this group toward breast cancer care could be empowering, the researchers add.

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