The New York State Breast Cancer Provider Discussion Law on Breast Reconstruction Rates: A Survey of New York State Surgeons
Yoshiko Toyoda, MD, Christine Rohde, MD, MPH.
NewYork-Presbyterian Hospital, New York, NY, USA.
Background: Breast reconstruction is covered by insurance, but reconstruction rates remain low. In response to studies which found breast surgeons serve as gatekeepers of reconstructive care, New York State (NYS) instituted the Breast Cancer Provider Discussion Law of 2010, which mandated breast surgeons provide education and plastic surgical referral at the time of cancer diagnosis. We previously demonstrated increased reconstruction rates from 2008-2014, especially among historically disadvantaged patients. To supplement these results, we conducted a provider-based survey of NYS breast surgeons on law awareness and changes in their practices with an emphasis on changes in social disparities in breast reconstruction. Methods: An anonymous electronic survey was distributed in three deployments to members of the American College of Surgeons who were designated as practicing breast surgery. Participants were queried on demographic information and law awareness. Participants were then asked about discussion of options, referral, and follow up with their breast cancer patients both before the law and currently. Finally, participants provided optional open-ended responses on the impact of the law on their practices, specifically with regard to social disparities, and their opinions on the effect of breast reconstruction on their patients. Results: Of the 281 functioning email addresses identified in the directory, 31 responded (response rate 11.0%), of which 28 performed oncologic breast surgery. Half of the respondents were female, and 35.7% were in academic practice. Nearly 86% were aware of the law, most commonly through surgical societies (25.0%), then the news media, hospital/medical centers, or colleagues (17.9% each). Prior to the law, 89.3% always discussed reconstruction with patients undergoing oncologic breast surgery, which increased to 96.4% currently (p = 0.2117). Only 14.3% of the respondents found that more than 75% of their patients received reconstruction prior to the law, which increased to 21.4% currently. Rates of always following up increased from 78.6% to 82.1%. Respondents overwhelmingly believed that reconstruction positively impacts women. While most respondents did not see changes in their own patient demographic, they agreed the law would theoretically benefit underrepresented minorities. Conclusion: This is the first provider-based study on the NYS Breast Cancer Provider Discussion Law of 2010. Improvement in the quality of life of breast cancer patients, especially those from historically disadvantaged backgrounds, is an important topic in reconstructive surgery health policy. Continued outcomes- and provider-based research may inform and shape future policies for continual improvement of patient care.
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