Breast Cancer, Breast Cancer Awareness Ribbon, Pink.

Nearly 40% of women diagnosed with breast cancer will require a mastectomy. For those patients, breast reconstruction surgery is a valuable part of comprehensive breast cancer care. A number of studies demonstrate that this care improves the health related quality of life (hrQoL), self-esteem and sexuality of patients.

Despite the benefits of breast reconstruction, women from Appalachia, a cultural region in the Eastern United States that stretches from the Southern Tier of New York State to northern Alabama and Georgia, are less likely to have the surgery than non-Appalachian breast cancer patients.

This is the conclusion from researchers at the University of Kentucky Markey Cancer Center, based on a retrospective, population-based cohort study looking at data from January 1, 2006, to December 31, 2015.

The results from their study were published in the December 2019 edition of Annals of Plastic Surgery, researchers used data from the Kentucky Cancer Registry to examine the disparities of breast cancer care between women in Appalachian and non-Appalachian Kentucky.

Breast cancer patients from Appalachia were 46% less likely to receive breast reconstruction surgery following a mastectomy. They were also older than their non-Appalachian counterparts and were more likely to have advanced stages of cancer, signs that suggest a lack of adequate care.

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Health disparities
Health disparities in Appalachia are well-documented and access to and delivery of care remain a challenge for women with breast cancer who live in the region, noted Henry C. Vasconez, MD, FACS, UK HealthCare’s William S. Farish Endowed Chair of Plastic Surgery, and Ryan C. DeCoster, MD, a postdoctoral research fellow with the UK Division of Plastic and Reconstructive Surgery and Markey Cancer Center.

While geographic distance to a plastic surgeon is a contributing factor, the lack of patient education plays a big role in the disparity. Many patients in Appalachian Kentucky are not told breast reconstruction is an option during their initial diagnosis and are therefore not referred to a reconstructive surgeon.

“Timely access to reconstructive breast surgery can improve quality of life,” Vasconez explained.

“Better education and awareness to all affected patients, especially those in Appalachia, provides for overall better comprehensive care,” Vasconez added.

“The hope is that these findings will raise awareness of the benefits of breast reconstructive surgery and support efforts to increase access to comprehensive breast cancer care for women in the region, and that includes access to a reconstructive plastic surgeon,” DeCoster concluded.

However, while the rates of breast reconstruction have increased over time in both women in Appalachian and non-Appalachian Kentucky, the researchers observed that access to comprehensive breast cancer care still remains a challenge for women from Kentucky’s Appalachian region.

DeCoster RC, Stout MA, Burns JC, et al. Appalachian Status Is a Negative Predictor of Breast Reconstruction Following Breast Cancer Resection. Ann Plast Surg. 2019;83(6):e15–e19. doi:10.1097/SAP.0000000000001965 [Pubmed][Article]

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