Background Inadequate access to breast reconstruction was a motivating factor underlying
Background Inadequate access to breast reconstruction was a motivating factor underlying passage of the Women’s Health and Cancer Rights Act. including linear regression were performed. Results Patients who underwent breast reconstruction had to travel farther than those who had mastectomy alone (< 0.01). A linear correlation was demonstrated between travel distance and reconstruction rates (< 0.01). The mean distances traveled by patients who underwent reconstruction at community comprehensive community or academic programs were 10.3 19.9 and 26.2 miles respectively (< 0.01). Reconstruction rates were significantly greater at academic programs. Patients traveled farther to undergo autologous compared with prosthetic reconstruction. Conclusions Although greater patient awareness and insurance coverage have contributed to increased breast reconstruction rates in the United States the presence of geographic barriers suggests an unmet need. Academic programs have the greatest reconstruction rates Gynostemma Extract but are located farther from patients’ residences. Increasing the number of plastics surgeons especially in community centers would be one method of addressing this inequality. Access to health care is a major source of outcomes variation among populations.1 Inadequate access to breast reconstruction was a motivating factor underlying passage of the Women’s Health and Cancer Rights Act in Gynostemma Extract 1998 which mandated all-payer coverage for postmastectomy reconstruction.2 Although passage of this law represented progress additional legislation was needed to ensure that patients were aware of this health insurance benefit. For example New York State passed legislation requiring surgeons HOXA2 to discuss the availability of breast reconstruction with patients before mastectomy provide information about insurance coverage and if necessary refer them to a hospital where reconstruction is available.3 Ratification of such laws may be one reason immediate breast reconstruction rates rose in the United States from 20.8 percent to 37.8 percent between 1998 and 2008.4 Despite these improvements it is unclear whether all patients interested in breast reconstruction are aware of or undergo this procedure. The impact of disparities such as race and insurance type on access to services such as breast reconstruction has been documented.5–9 Geography is an additional barrier10 evaluated to a lesser extent. Geographic disparities within breast reconstruction may arise from regional differences in plastic surgeon density. In addition greater numbers of autologous transfers are now being performed in a limited number of centers (i.e. market concentration) potentially restricting patient access to this method of reconstruction.11 The impact of Gynostemma Extract geography on the method of breast reconstruction (i.e. implants versus autologous tissue) has not been specifically evaluated. Travel distance serves as a quantitative measurement to assess the presence of geographic disparities. The aim of this study is to determine whether travel distance influences the rate and method of breast reconstruction services. The primary hypothesis is that a greater travel distance to undergo reconstruction is necessary compared with mastectomy alone. The secondary hypothesis Gynostemma Extract is that a greater travel distance is needed for autologous than for prosthetic reconstruction because of a recent market concentration for these procedures.12 PATIENTS AND METHODS An analysis of travel distance for women undergoing mastectomies for breast cancer was performed using the National Cancer Database. The National Cancer Database is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society that collects information from more than 1500 Commission on Cancer–accredited facilities in the United States and Puerto Rico. These data represent approximately 70 percent of new cancer diagnoses nationwide. Approval was obtained from the Commission on Cancer’s review board. Patients were included in the study if they underwent a unilateral or bilateral mastectomy with or without reconstruction for breast cancer from 1998 to 2011. Surgical procedures were.