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Multilevel Analysis of the Impact of Community vs Patient Factors on Access to Immediate Breast Reconstruction Following Mastectomy in Maryland—Invited Critique
David M. Euhus, MD
Arch Surg. 2008;143(11):1081.
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Rosson and colleagues have hypothesized that the frequency of immediate reconstruction following mastectomy is a surrogate for "optimal" breast cancer therapy. They report a disparity in the rate of immediate reconstruction that is related to age, race/ethnicity, education status, income, and community population density. Implicit in this is the assertion that lower-income African American women in more rural areas are not receiving the same quality of breast cancer treatment as higher-income urban white women. Many factors influence the decision for immediate reconstruction after mastectomy. Some of these are purely biologic; for instance, advanced primary cancers often require postmastectomy chest wall radiation therapy, making immediate reconstruction less desirable. Other factors are related to the expediencies and biases of the patient, the expediencies and biases of the surgeon (often assimilated by the patient), and simple logistics such as local availability of expertise. Systematic inequities in our health care . . . [Full Text of this Article]
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Multilevel Analysis of the Impact of Community vs Patient Factors on Access to Immediate Breast Reconstruction Following Mastectomy in Maryland
Gedge D. Rosson, Navin K. Singh, Nita Ahuja, Lisa K. Jacobs, and David C. Chang
Arch Surg. 2008;143(11):1076-1081.
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