Reconstructive surgery and immigration status among females with breast cancer

Background — Immigrants are susceptible to marginalization within health care systems, and breast reconstruction after mastectomy is a procedure prone to disparities in delivery. We sought to measure differences in immediate and delayed reconstruction between immigrant and nonimmigrant females with breast cancer in urban Ontario, Canada.

Methods — We conducted a retrospective population-based study using linked administrative databases held at ICES. We included female patients with stage I to III breast cancer, diagnosed from January 2010 through April 2016, who were treated with mastectomy. We excluded those with in situ disease only, missing staging data, another cancer diagnosis, no provincial health coverage, or rural residence. We categorized patients as immigrants if they arrived in Canada from 1985 onward. We compared the proportions of immigrants and nonimmigrants who underwent breast reconstruction.

Results — We identified 2174 immigrants and 12 052 nonimmigrants. Immigrants were younger (mean age 53.3 yr v. 62.2 yr) and more often had stage III disease (32.8% v. 29.7%). They were less likely to undergo reconstruction (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.48 to 0.62). In stratified analyses by age (< 50 yr and ≥ 50 yr), compared with nonimmigrants, the odds ratio for reconstruction was 0.51 (95% CI 0.44 to 0.60) in immigrants younger than 50 years and 1.12 (95% CI 0.94 to 1.30) in those aged 50 years and older. The difference between groups was more pronounced for delayed (OR 0.48, 95% CI 0.41 to 0.56) than immediate (OR 0.83, 95% CI 0.68 to 1.00) reconstruction. Immigrants were less likely to undergo reconstruction regardless of disease stage. Those from East Asian or Pacific, South Asian, and sub-Saharan African regions were least likely to undergo reconstruction.

Conclusion — Immigrant females were less likely to undergo breast reconstruction than nonimmigrant females. This study identified subgroups for further research to understand how to ensure equitable access to this important health care resource.