The influence of race/ethnicity and place of service on breast reconstruction for Medicare beneficiaries with mastectomy

Tracy Onega, Julie Weiss, Karla Kerlikowske, Karen Wernli, Diana S M Buist, Louise M. Henderson, Martha Goodrich, Jennifer Alford-Teaster, Beth Virnig, Anna N A Tosteson, Wendy DeMartini, Rebecca Hubbard

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Racial disparities in breast reconstruction for breast cancer are documented. Place of service has contributed to disparities in cancer care; but the interaction of race/ethnicity and place of service has not been explicitly examined. We examined whether place of service modified the effect of race/ethnicity on receipt of reconstruction. We included women with a mastectomy for incident breast cancer in SEER-Medicare from 2005-2009. Using Medicare claims, we determined breast reconstruction within 6 months. Facility characteristics included: rural/urban location, teaching status, NCI Cancer Center designation, cooperative oncology group membership, Disproportionate Share Hospital (DSH) status, and breast surgery volume. Using multivariable logistic regression, we analyzed reconstruction in relation to minority status and facility characteristics. Of the 17,958 women, 14.2% were racial/ethnic women of color and a total of 9.3% had reconstruction. Caucasians disproportionately received care at non-teaching hospitals (53% v. 42%) and did not at Disproportionate Share Hospitals (77% v. 86%). Women of color had 55% lower odds of reconstruction than Caucasians (OR = 0.45; 95% CI 0.37-0.55). Those in lower median income areas had lower odds of receiving reconstruction, regardless of race/ethnicity. Odds of reconstruction reduced at rural, non-teaching and cooperative oncology group hospitals, and lower surgery volume facilities. Facility effects on odds of reconstruction were similar in analyses stratified by race/ethnicity status. Race/ethnicity and facility characteristics have independent effects on utilization of breast reconstruction, with no significant interaction. This suggests that, regardless of a woman's race/ethnicity, the place of service influences the likelihood of reconstruction.

Original languageEnglish (US)
Article number416
Pages (from-to)1-9
Number of pages9
Issue number1
StatePublished - 2014

Bibliographical note

Funding Information:
This work was supported by funding from the National Institute of Health, National Cancer Institute under grant R01 CA149365-01. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.


  • Breast cancer
  • Disparities
  • Mastectomy
  • Reconstruction


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