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Barriers and facilitators to breast reconstruction in ethnic minority women—A systematic review

Published:November 04, 2020DOI:https://doi.org/10.1016/j.bjps.2020.10.055

      Summary

      Introduction

      Post-mastectomy breast reconstruction (PMBR) is an important component of the multidisciplinary care of breast cancer patients. Despite the improved quality of life, significant racial disparities exist in the receipt of PMBR. Given the increasing population of Black, Asian and minority ethnic (BAME) women in UK, it is important to address this disparity. Our review aims to identify the barriers and facilitators influencing the uptake of PMBR in BAME women and raise awareness for physicians on interventions that could improve uptake of PMBR in BAME women.

      Methods

      The methodology outlined by the Cochrane guidelines was used to structure this systematic review. Systematic searches for qualitative studies on barriers and/or facilitators to PMBR in ethnic women published in English were conducted. The following databases were searched from their inception up to June 2019: MEDLINE, EMBASE, PubMed, Cochrane Library, Google Scholar and Scopus. Reference lists of all included articles and relevant systematic reviews were also hand-searched for possible additional publications. Publication year or status restrictions were not applied. Only full text articles published in English and by peer reviewed journals are included. Exclusion criteria were as follows: quantitative studies on barriers and/or facilitators to PMBR, abstracts, conference proceedings, non-English language and non-specific to BAME women. A thematic synthesis approach was used through the development of sub-themes and themes from the findings of the included qualitative studies.

      Results

      Five studies satisfied the inclusion and exclusion criteria. Three overarching themes emerged from our review: physician-associated factors (physician recommendations), patient-associated factors (knowledge, language, community and cultural, emotions, logistics, patient characteristics) and system-associated factors (insurance coverage, income status).

      Conclusion

      Our systematic review suggests that there is a paucity of data in the literature on the barriers and facilitators to PMBR in BAME women. Considering the expanding population of BAME women and increasing breast cancer incidence, it is imperative that future research in this field is carried out. Physician and patient-associated factors were identified as the most important yet modifiable factors. Adopting a combination of culturally tailored interventions targeting these factors may help improve the access of PMBR in BAME women.

      Registration

      Prospero ID: CRD42019133233.

      Keywords

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      References

      1. Breast cancer | World Cancer Research Fund UK. https://www.wcrf-uk.org/uk/preventing-cancer/cancer-types/breast-cancer. Accessed December 4, 2019.

      2. Breast cancer statistics | Cancer Research UK. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer#heading-Zero. Accessed December 4, 2019.

        • DeSantis C.E.
        • Fedewa S.A.
        • Goding Sauer A.
        • Kramer J.L.
        • Smith R.A.
        • Jemal A
        Breast cancer statistics, 2015: convergence of incidence rates between black and white women.
        CA Cancer J Clin. 2016; 66: 31-42https://doi.org/10.3322/caac.21320
      3. Ethnicity and National Identity in England and Wales - Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/ethnicity/articles/ethnicityandnationalidentityinenglandandwales/2012-12-11. Accessed December 3, 2019.

      4. U.S. Population Projections: 2005-2050 | Pew Research Center. https://www.pewresearch.org/hispanic/2008/02/11/us-population-projections-2005-2050/. Accessed January 23, 2020.

        • Franzoi M.A.
        • Schwartsmann G.
        • de Azevedo S.J.
        • Geib G.
        • Zaffaroni F.
        • Liedke P.E.R
        Differences in breast cancer stage at diagnosis by ethnicity, insurance status, and family Income in young women in the USA.
        J Racial Ethn Heal Disparities. 2019; 6: 909-916https://doi.org/10.1007/s40615-019-00591-y
        • Wilkins E.
        • Cederna P.
        • Lowery J.
        • et al.
        Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan breast reconstruction outcome study.
        Plast Reconstr Surg. 2000; 106: 1014-1025
        • Jagsi R.
        • MD P.
        • Li Y.
        • et al.
        Patient-reported quality of life and satisfaction with cosmetic outcomes after breast conservation and mastectomy with and without reconstruction: results of a survey of breast cancer survivors.
        Ann Surg. 2015; 261: 1198-1206https://doi.org/10.1097/SLA.0000000000000908
        • Nozawa K.
        • Ichimura M.
        • Oshima A.
        • et al.
        The present state and perception of young women with breast cancer towards breast reconstructive surgery.
        Int J Clin Oncol. 2014; 20: 324-331https://doi.org/10.1007/s10147-014-0716-0
        • Reaby L.L
        Reasons why women who have mastectomy decide to have or not to have breast reconstruction.
        Plast Reconstr Surg. 1998; 101: 1810-1818https://doi.org/10.1097/00006534-199806000-00006
        • Jeevan R.
        • Cromwell D.A.
        • Browne J.P.
        • et al.
        Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England.
        J Plast Reconstr Aesthet Surg. 2014; 67: 1333-1344https://doi.org/10.1016/j.bjps.2014.04.022
        • Jagsi R.
        • Jiang J.
        • Momoh A.O.
        • et al.
        Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States.
        J Clin Oncol. 2014; 32: 919-926https://doi.org/10.1200/JCO.2013.52.2284
        • Jeevan R.
        • Cromwell D.A.
        • Browne J.P.
        • et al.
        Regional variation in use of immediate breast reconstruction after mastectomy for breast cancer in England.
        Eur J Surg Oncol. 2010; 36: 750-755https://doi.org/10.1016/j.ejso.2010.06.008
        • Butler P.D.
        • Nelson J.A.
        • Fischer J.P.
        • et al.
        Racial and age disparities persist in immediate breast reconstruction: an updated analysis of 48,564 patients from the 2005 to 2011 American College of Surgeons national surgery quality improvement program data sets.
        Am J Surg. 2016; 212: 96-101https://doi.org/10.1016/j.amjsurg.2015.08.025
        • Greenberg C.C.
        • Schneider E.C.
        • Lipsitz S.R.
        • et al.
        Do variations in provider discussions explain socioeconomic disparities in postmastectomy breast reconstruction?.
        J Am Coll Surg. 2008; 206: 605-615https://doi.org/10.1016/j.jamcollsurg.2007.11.017
        • Alderman A.K.
        • McMahon L.
        • Wilkins E.G.
        The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors.
        Plast Reconstr Surg. 2003; 111: 695-703https://doi.org/10.1097/01.PRS.0000041438.50018.02
        • Alderman A.K.
        • Hawley S.T.
        • Janz N.K.
        • et al.
        Racial and ethnic disparities in the use of postmastectomy breast reconstruction: results from a population-based study.
        J Clin Oncol. 2009; 27: 5325-5330https://doi.org/10.1200/JCO.2009.22.2455
        • Tseng J.F.
        • Kronowitz S.J.
        • Sun C.C.
        • et al.
        The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer.
        Cancer. 2004; 101: 1514-1523https://doi.org/10.1002/cncr.20529
        • Yang R.L.
        • Newman A.S.
        • Reinke C.E.
        • et al.
        Racial disparities in immediate breast reconstruction after mastectomy: impact of state and federal health policy changes.
        Ann Surg Oncol. 2013; 20: 399-406https://doi.org/10.1245/s10434-012-2607-9
        • Sharma K.
        • Grant D.
        • Parikh R.
        • Myckatyn T
        Race and breast cancer reconstruction: is there a health care disparity?.
        Plast Reconstr Surg. 2016; 138: 354-361https://doi.org/10.1097/PRS.0000000000002344
        • Moher D.
        • Shamseer L.
        • Clarke M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015; 4https://doi.org/10.1186/2046-4053-4-1
      5. CASP Checklists - CASP Critical Appraisal Skills Programme. https://casp-uk.net/casp-tools-checklists/. Accessed March 4, 2020.

        • Ishak A.
        • Yahya M.
        • Halim A
        Breast reconstruction after mastectomy: a survey of surgeons’ and patients’ perceptions.
        Clin Breast Cancer. 2018; 18: e1011-e1021https://doi.org/10.1016/j.clbc.2018.04.012
        • R. F
        • M.M. C.
        • C M.
        • et al.
        A qualitative study of breast reconstruction decision-making among Asian immigrant women living in the United States.
        Plast Reconstr Surg. 2017; 139: 360e-368ehttps://doi.org/10.1097/PRS.0000000000002947
        • Rubin L.R.
        • Chavez J.
        • Alderman A.
        • Pusic A.L
        “Use what god has given me”: difference and disparity in breast reconstruction.
        Psychol Heal. 2013; 28: 1099-1120https://doi.org/10.1080/08870446.2013.782404
        • M M.
        • L Y.
        • A.K. A.
        • et al.
        Access to breast reconstruction after mastectomy and patient perspectives on reconstruction decision making.
        JAMA Surg. 2014; 149: 1015-1021https://doi.org/10.1001/jamasurg.2014.548
        • S T.P
        • K K.B.
        • R K.
        • et al.
        Health insurance coverage and racial disparities in breast reconstruction after mastectomy.
        Women's Heal Issues. 2014; 24: E261-E269https://doi.org/10.1016/j.whi.2014.03.001
        • Rowland J.H.
        Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors.
        J Natl Cancer Inst. 2000; 92: 1422-1429https://doi.org/10.1093/jnci/92.17.1422
        • Rowland J.H.
        • Holland J.C.
        • Chaglassian T.
        • Kinne D
        Psychological response to breast reconstruction: expectations for and impact on postmastectomy functioning.
        Psychosomatics. 1993; 34: 241-250https://doi.org/10.1016/S0033-3182(93)71886-1
        • Elder E.E.
        • Brandberg Y.
        • Björklund T.
        • et al.
        Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study.
        Breast. 2005; 14: 201-208https://doi.org/10.1016/j.breast.2004.10.008
        • Ganz P.A.
        Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study.
        Cancer Spectrum Knowl Environ. 2002; 94: 39-49https://doi.org/10.1093/jnci/94.1.39
        • Levine S.M.
        • Levine A.
        • Raghubir J.
        • Levine J.P
        A 10-year review of breast reconstruction in a university-based public hospital.
        Ann Plast Surg. 2012; 69: 376-379https://doi.org/10.1097/SAP.0b013e31824b26d2
        • Kruper L.
        • Xu X.
        • Henderson K.
        • Bernstein L
        Disparities in reconstruction rates after mastectomy for ductal carcinoma in situ (DCIS): patterns of care and factors associated with the use of breast reconstruction for DCIS compared with invasive cancer..
        Ann. Surg. Oncol. 2011; 18: 3210-3219https://doi.org/10.1245/s10434-011-2010-y
        • Kagawa-Singer M.
        • Wellisch D.K.
        • Durvasula R
        Impact of breast cancer on Asian American and Anglo American women.
        Cult Med Psychiatry. 1997; 21: 449-480https://doi.org/10.1023/A:1005314602587
        • Rosson G.
        • Singh N.
        • Ms M.D.
        • et al.
        Multilevel analysis of the impact of community vs. patient factors on access to immediate breast reconstruction following mastectomy in Maryland.
        Arch Surg. 2008; 143: 1076-1081
        • Rippy E.E.
        • Ainsworth R.
        • Sathananthan D.
        • Kollias J.
        • Bochner M.
        • Whitfield R.
        Influences on decision for mastectomy in patients eligible for breast conserving surgery.
        Breast. 2014; 23: 273-278https://doi.org/10.1016/j.breast.2013.12.009
        • Temple W.J.
        • Russell M.L.
        • Parsons L.L.
        • et al.
        Conservation surgery for breast cancer as the preferred choice: a prospective analysis.
        J Clin Oncol. 2006; 24: 3367-3373https://doi.org/10.1200/JCO.2005.02.7771
        • Preminger B.A.
        • Trencheva K.
        • Chang C.S.
        • et al.
        Improving access to care: breast surgeons, the gatekeepers to breast reconstruction.
        J Am Coll Surg. 2012; 214: 270-276https://doi.org/10.1016/j.jamcollsurg.2011.11.014
        • Ananian P.
        • Houvenaeghel G.
        • Protière C.
        • et al.
        Determinants of patients’ choice of reconstruction with mastectomy for primary breast cancer.
        Ann Surg Oncol. 2004; 11: 762-771https://doi.org/10.1245/ASO.2004.11.027
        • Postolică R.
        • Luncă S.
        • Porumb V.
        • Nicolescu S.
        • Dimofte G.
        Patients choose against reconstruction after mastectomy for breast cancer. Do women disregard the quality of their future life?.
        Revista Romana de Bioetica. 2013; 11: 21-30
        • Takahashi M.
        • Kai I.
        • Hisata M.
        • Higashi Y
        The Association between breast surgeons’ attitudes toward breast reconstruction and their reconstruction-related information-giving behaviors: a nationwide survey in Japan.
        Plast Reconstr Surg. 2006; 118: 1507-1514https://doi.org/10.1097/01.prs.0000233149.36751.d2
        • Jenkins C.N.H.
        • McPhee S.J.
        • Bird J.A.
        • et al.
        Effect of a media-led education campaign on breast and cervical cancer screening among Vietnamese-American women.
        Prev Med Baltim. 1999; 28: 395-406https://doi.org/10.1006/pmed.1998.0444
        • Green A.R.
        • Carney D.R.
        • Pallin D.J.
        • et al.
        Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients.
        J Gen Intern Med. 2007; 22: 1231-1238https://doi.org/10.1007/s11606-007-0258-5
        • Morrow M.
        • Scott S.K.
        • Menck H.R.
        • Mustoe T.A.
        • Winchester D.P
        Factors influencing the use of breast reconstruction postmastectomy: a national cancer database study.
        J Am Coll Surg. 2001; 192: 1-8https://doi.org/10.1016/s1072-7515(00)00747-x
        • Cooper L.A.
        • Roter D.L.
        • Carson K.A.
        • et al.
        The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care.
        Am J Public Health. 2012; 102: 979-987https://doi.org/10.2105/AJPH.2011.300558
        • Chapman K.R.
        • Tashkin D.P.
        • Pye D.J
        Gender bias in the diagnosis of COPD.
        Chest. 2001; 119: 1691-1695https://doi.org/10.1378/chest.119.6.1691
        • Rubin L.R.
        • Fitts M.L.
        • Becker A.E
        “Whatever feels good in my soul”: body ethics and aesthetics among African American and Latina women.
        Cult Med Psychiatry. 2003; 27: 49-75https://doi.org/10.1023/A:1023679821086
        • Odoms-Young A.
        Factors that influence body image representations of black Muslim women.
        Soc Sci Med. 2008; : 2573-2584https://doi.org/10.1016/j.socscimed.2008.02.008
        • PARKER S.
        • NICHTER M.
        • NICHTER M.
        • VUCKOVIC N.
        • SIMS C.
        • RITENBAUGH C
        Body image and weight concerns among African American and white adolescent females: differences that make a difference.
        Hum Organ. 1995; 54: 103-114https://doi.org/10.2307/44127140
        • Rubin L.R.
        • Chavez J.
        • Alderman A.
        • Pusic A.L
        Use what god has given me”: difference and disparity in breast reconstruction.
        Psychol Heal. 2013; 28: 1099-1120https://doi.org/10.1080/08870446.2013.782404
        • Duxbury P.J.
        • Gandhi A.
        • Kirwan C.C.
        • Jain Y.
        • Harvey J.R
        Current attitudes to breast reconstruction surgery for women at risk of post-mastectomy radiotherapy: a survey of UK breast surgeons.
        Breast. 2015; 24: 502-512https://doi.org/10.1016/j.breast.2015.05.002
        • Sergesketter A.R.
        • Thomas S.M.
        • Lane W.O.
        • et al.
        Decline in racial disparities in postmastectomy breast reconstruction.
        Plast Reconstr Surg. 2019; 143: 1560-1570https://doi.org/10.1097/PRS.0000000000005611
        • Bauder A.R.
        • Gross C.P.
        • Killelea B.K.
        • Butler P.D.
        • Kovach S.J.
        • Fox J.P
        The relationship between geographic access to plastic surgeons and breast reconstruction rates among women undergoing mastectomy for cancer..
        Ann Plast Surg. 2017; 78: 324-329https://doi.org/10.1097/SAP.0000000000000849
        • Platt J.
        • Zhong T.
        • Moineddin R.
        • et al.
        Geographic variation immediate and delayed breast reconstruction utilization in Ontario, Canada and plastic surgeon availability: a population-based observational study.
        World J Surg. 2015; 39: 1909-1921https://doi.org/10.1007/s00268-015-3060-2
        • Butler P.D.
        • Familusi O.
        • Serletti J.M.
        • Fox J.P
        Influence of race, insurance status, and geographic access to plastic surgeons on immediate breast reconstruction rates.
        Am J Surg. 2018; 215: 987-994https://doi.org/10.1016/j.amjsurg.2017.09.037
        • Taylor V.
        • Thompson B.
        • Lessler D.
        • et al.
        A clinic-based mammography intervention targeting inner-city women.
        J Gen Intern Med. 1999; 14: 104-111https://doi.org/10.1046/j.1525-1497.1999.00295.x
        • Paskett E.D.
        • Tatum C.M.
        • D'Agostino R.
        • et al.
        Community-based interventions to improve breast and cervical cancer screening: results of the Forsyth county cancer screening (FoCaS) project.
        Cancer Epidemiol Prev Biomark. 1999; 8: 399-406
        • Musa D.
        • Schulz R.
        • Harris R.
        • Silverman M.
        • Thomas S.B
        Trust in the health care system and the use of preventive health services by older black and white adults.
        Am J Public Health. 2009; 99: 1293-1299https://doi.org/10.2105/AJPH.2007.123927
        • Zacharias T.
        • Wang W.
        • Dao D.
        • et al.
        HBV outreach programs significantly increase knowledge and vaccination rates among Asian pacific islanders.
        J Community Health. 2015; 40: 619-624https://doi.org/10.1007/s10900-014-9975-y