Nav: Home

Insurance, distance to care can be barriers to breast reconstruction

July 28, 2016

CHAPEL HILL - Women were less likely to have breast reconstruction surgery after mastectomy if they had Medicaid or Medicare rather than private insurance or if they lived 10 or more miles from a plastic surgeon's office, a University of North Carolina Lineberger Comprehensive Cancer Center study has found.

Researchers said the findings, published in the journal Plastic and Reconstructive Surgery, highlight additional barriers to breast reconstruction alongside other obstacles that have been identified including race, socioeconomic class and age. The new data are concerning, researchers said, as they say the procedure can help with self-esteem, sexuality and body image after cancer treatment.

"We know that breast cancer affects not only the physical wellbeing of the patient, but also her psychosocial wellbeing, and we know that breast reconstruction can help address those issues," said the study's first author Michelle Roughton, MD, an assistant professor of surgery and the program director for the UNC School of Medicine Section of Plastic and Reconstructive Surgery. "These findings highlight the fact that there are more barriers to breast reconstruction access than we previously recognized."

In the study, researchers analyzed insurance claims data for 5,381 women in North Carolina diagnosed with breast cancer between 2003 and 2006. The study included women with Medicaid, Medicare, or private insurance health plans, who had a mastectomy within six months of diagnosis and who continued to maintain their insurance coverage for at least two years after the procedure. Twenty percent of women included in the study chose breast reconstruction.

The study drew upon UNC Lineberger's Integrated Cancer Information Surveillance System (ICISS), a research tool that links to population and clinical data to health claims data for about 5.5 million people insured by Medicare, Medicaid, or private insurance policies.

In the raw, unadjusted data, they found that 56 percent of women with private insurance received breast reconstruction, compared with 10 percent of women with Medicare, or 11 percent of those with Medicaid. The study found after adjusting for related patient factors such as age or stage of disease, Medicare recipients had 42 percent lower odds of receiving breast reconstruction than women with private insurance, and women with Medicaid had 76 percent lower odds.

"Even when you control for age, the type of insurance patients had was still an independent predictor of whether patients received breast reconstruction," Roughton said.

By federal law, group health plans that pay for mastectomy must also cover breast prosthetics and reconstructive procedures. Medicare does cover the procedure, while Medicaid coverage can vary by state. Roughton said one factor affecting access to reconstruction may be that not all surgeons accept all types of insurance for the procedure.

"As doctors working for the state's flagship cancer hospital, we aim to provide breast reconstruction to every woman who desires it despite distance and payer," Roughton said.

Distance to the nearest plastic surgeon was also predictive of whether women underwent reconstruction. The study found that women living 20 or more miles away had 27 percent lower odds of receiving breast reconstruction compared to women living within 10 miles of a surgeon. Women living 10 to 20 miles away from the nearest surgeon had 22 percent lower odds.

The study also found that minority women had 50 percent lower odds of receiving reconstruction compared to non-Hispanic whites, and, consistent with previous studies, they found that increasing age at diagnosis, advanced cancer stage, and radiation treatment also decreased

odds. Roughton said she has tried to overcome distance obstacles for her patients by using telemedicine for initial consultations, and by using text and email to help assess patients after the operation.
-end-
The study was supported by the University Cancer Research Fund.

In addition to Roughton, other authors include: Paul DiEgidio, MD, of the UNC School of Medicine; Lei Zhou, MSPH, of UNC Lineberger; Karyn Stitzenberg, MD, MPH, of the UNC School of Medicine; and Anne Marie Meyer, PhD, of UNC Lineberger and the UNC Gillings School of Global Public Health.

UNC Lineberger Comprehensive Cancer Center

Related Breast Cancer Articles:

Does MRI plus mammography improve detection of new breast cancer after breast conservation therapy?
A new article published by JAMA Oncology compares outcomes for combined mammography and MRI or ultrasonography screenings for new breast cancers in women who have previously undergone breast conservation surgery and radiotherapy for breast cancer initially diagnosed at 50 or younger.
Blood test offers improved breast cancer detection tool to reduce use of breast biopsy
A Clinical Breast Cancer study demonstrates Videssa Breast can inform better next steps after abnormal mammogram results and potentially reduce biopsies up to 67 percent.
Surgery to remove unaffected breast in early breast cancer increases
The proportion of women in the United States undergoing surgery for early-stage breast cancer who have preventive mastectomy to remove the unaffected breast increased significantly in recent years, particularly among younger women, and varied substantially across states.
Breast cancer patients with dense breast tissue more likely to develop contralateral disease
Breast cancer patients with dense breast tissue have almost a two-fold increased risk of developing disease in the contralateral breast, according to new research from The University of Texas MD Anderson Cancer.
Some early breast cancer patients benefit more from breast conservation than from mastectomy
Breast conserving therapy (BCT) is better than mastectomy for patients with some types of early breast cancer, according to results from the largest study to date, presented at ECC2017.
More Breast Cancer News and Breast Cancer Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...