by Mark Fisher, MD (@DrMarkFisher)
August brought with it another excellent #PRSJournalClub, this time focused on access to care. Roughton et al. used a linked data set combining a state cancer registry with insurance claims to study the variables that predict likelihood of reconstruction after mastectomy. They focused on geographical distance to a plastic surgeon in addition to other variables such as demographics, insurance, and timing of reconstruction.
Overall, they looked at 5381 patients who met their inclusion criteria. Of those, only 20% underwent postmastectomy reconstruction. Interestingly, the authors found that distance to a breast reconstructive surgeon was significantly and independently associated with receipt of reconstruction. Specifically, woman living 10-20 miles from a plastic surgeon has 22 percent lower odds of undergoing and reconstruction, and women living 20+ miles from a plastic surgeon had 27% lower odds when compared to women living less than 10 miles away.
In addition, Roughton et al. discovered that women with federally funded health care also had significantly lower odds of undergoing reconstruction compared to women with private insurance. Their study also reinforced prior data that showed that minority women were less likely to undergo breast reconstruction compared to non-Hispanic whites.
An expert discussion by Dr. Amy Alderman provided an interesting and in-depth discussion touching on some of the political factors as well as questioning what changes may have occurred since 2006 (the endpoint of the study data).
Some outstanding tweets:
And a great Q&A:
Nima Khavanin: Is there a role 4 new fed/state policy in overcoming obstacles (distance or otherwise) to recon?
All past Journal Club podcasts are available here.
The next Journal Club podcast will be September 18th and 19th.