INTRODUCTION: The option to undergo breast reconstruction following mastectomy significantly impacts patients’ breast cancer treatment choices. Previous studies using the Surveillance, Epidemiology, and End Results (SEER) program suggest that sociodemographic factors including patient age, race, and geographic location influence the utilization of postmastectomy breast reconstruction in the United States. Notably, Alderman et al (2003) have shown that African American, Hispanic, and Asian women are significantly less likely to undergo reconstruction when compared with Caucasian women. Although studies have shown a post-mastectomy local recurrence rate ranging from five to thirty percent, few studies have investigated survival rates following breast reconstruction. In this study, we use the SEER database to investigate post-reconstructive survival rates between 1998 and 2002 based on race.
METHODS: Data from the Surveillance, Epidemiology, and End Results (SEER) Program was used for this study. The designated study period was from 1998 to 2002 using the SEER 17 November 2006 database. Patient selection criteria were all females diagnosed with intraductal carcinoma (ICD-O-3 8500), lobular carcinoma (ICD-O-3 8520), infiltrating ductal carcinoma (ICD-O-3 8521), intraductal and lobular carcinoma (ICD-O-3 8522), Paget disease (ICD-O-3 8540), Paget disease and infiltrating duct carcinoma (ICD-O-3 8541), or Paget disease and intraductal carcinoma (ICD-O-3 8543) and treated with mastectomy (primary site surgery codes 30-80). The primary outcome measures were the frequency of reconstruction in African American and Caucasian patients. Secondary outcomes of interest were the post-reconstructive survival rates determined by Kaplan-Meier method with cause of death attributed to all causes, non-neoplastic causes, any malignant cancer, or breast cancer in Caucasian and African American women.
RESULTS: A total of 75,895 mastectomy cases were found, of which 68,475 had a known reconstructive status. A total of 11,068 patients were reconstructed (16.2%). Of the 57,267 mastectomy cases in Caucasian women with known reconstructive outcome, 9,711 were reconstructed (17.0%). Of the 5,243 mastectomy cases in African American women with known reconstructive outcome, 813 were reconstructed (15.5%). The observed post-reconstructive 5-year survival in all patients was 89.9%; the observed 5-year post-reconstructive survival rate in African American patients and Caucasian patients were 81.5% and 90.6% respectively. When censoring out all malignancy-related deaths, the 5-year post-reconstructive cause-specific survival rate was 99.0% overall, and African American and Caucasian 5-year post-reconstructive survival rates were 99.3% and 99.0% respectively. However, when censoring out all non-malignancy-related deaths, 5-year post-reconstructive cause-specific survival was 91.3% overall; survival rates in African Americans and Caucasians were 82.6% and 92.0% respectively. Lastly when defining death only from breast cancer, the 5-year post-reconstructive cause-specific survival was 91.9% overall; survival rates in African Americans and Caucasians were 83.9% and 93.1% respectively.
DISCUSSION: In this study we show that the percentages of post-mastectomy African American and Caucasian women undergoing reconstruction are similar. We also report that Caucasian women have a higher post-reconstructive survival rate than African American women when counting deaths from all cause, any malignant tumor, or breast cancer only. However, African American and Caucasian women have a similar post-reconstructive survival rate when counting deaths only from non-neoplastic causes. Logistic regression analysis will be performed to determine whether these differences are significant. This study is limited to the four-year time-frame from 1998-2002 and does not account for differences in tumor stage upon presentation between Caucasian and African American women. Additionally, this study is specific to the institutions included in the SEER database and relies on cause of death coding from the SEER database. Substantial future research into post-reconstructive survival rates is warranted.