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Rurality is Associated with Surgical Timeline Disparities in Breast Cancer Patients Undergoing Immediate Breast Reconstruction
Lola Ortiz-Whittingham
*, Michael Mazarei, Shayan M. Sarrami, Carolyn De La Cruz
Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
Background: Timely surgery is a critical component of breast cancer treatment. Immediate breast reconstruction (IBR) offers important quality of life benefits, however disparities in surgical timing among IBR patients remain. Therefore, we evaluated a statewide patient population to identify risk factors for extended time to surgery among IBR patients.
Methods: We conducted a retrospective cohort study of a Pennsylvania Cancer Registry which identified patients diagnosed with breast cancer from 2011 to 2021. Adult patients not receiving neoadjuvant therapy and undergoing total, modified, radical, or subcutaneous mastectomy with or without immediate reconstruction were included in our study. We defined extended length to surgery as time from diagnosis to first surgery greater than 60 days. Rurality was defined using Rural-Urban Commuting Area Codes. Multivariable modified Poisson regression with robust standard errors was used to estimate adjusted relative risks of extended time to surgery associated with rurality.
Results: 3,151 patients met inclusion criteria, of which 46% (n=1,436) underwent IBR. The median time from diagnosis to surgery among patients not undergoing IBR was 42 days (IQR 29-59) versus 60 days (IQR 43-78) in patients who underwent IBR, representing an 18-day longer median time to surgery (p<.001). Among patients undergoing IBR, we found rural residence was significantly associated with a 1.31 times higher risk of extended length to surgery compared to urban residence (95% CI: 1.15-1.49, p=0.008) after adjusting for age, race, ethnicity, insurance, clinical stage, mastectomy type, reconstruction type, year of diagnosis, and Social Vulnerability Index. Rural residents undergoing IBR had an 11-day longer median time to surgery (69 days, IQR 49-83) compared to urban residents undergoing IBR (58 days, IQR 43-78) (p<.001).
Conclusion: Rurality may contribute to disparities in timely breast cancer care for patients undergoing IBR. Future work is needed to understand these patterns and ensure timely, coordinated reconstructive care for rural patients.
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