In a letter published in the January 25 issue of the Journal of the American Medical Association, Amy K. Alderman, MD, MPH, writes that, despite the mandated insurance coverage of breast reconstruction after mastectomy, fewer than 20% of women undergo the procedure. Disparities exist in its use among certain races, including African Americans, Hispanics, and Asians.

The findings, from a University of Michigan Health System study conducted between 1998 and 2002, indicated that, of the 51,184 women with breast cancer treated with mastectomy, only 16.5% underwent reconstruction.

“We know that women who undergo breast reconstruction gain large improvements in their emotional, social, and functional well-being, and hoped the law would increase use of reconstruction following mastectomy, since prior to the law, insurance companies did not cover the procedure,” Alderman says. “But our study found that the law has done nothing to improve usage among women. And with such large variations of use by geography and race, it brings up a lot of questions as to whether there is a problem, and if there is, how do we correct it?”

The study revealed that African Americans were half as likely to undergo reconstruction as Caucasians, as were Hispanics and Asians. The findings also showed that where a woman lives can factor into the likelihood that she will undergo reconstruction. Reconstruction rates were high in Detroit and Atlanta, but low throughout Iowa and Connecticut.

“Race seems to be a big predictor of whether or not a woman will undergo reconstruction,” Alderman says. “So we need to find out if certain races simply are not getting the knowledge they need to make an educated decision.”

To uncover factors beyond insurance that may be driving patient patterns with breast reconstruction, Alderman calls for further research into breast cancer patients’ knowledge and preferences about reconstruction and access to reconstructive surgeons, especially among women of different races and ethnicities.