Unveiling Inequities: Racial Disparities in Risk-Reducing Mastectomy for Breast Cancer Prevention

Abstract

This study investigated racial disparities in risk-reducing mastectomy (RRM) using data from the National Surgical Quality Improvement Program (20 08-2022). Among 1,285 women, minority patients, including Black women, had higher rates of obesity, hypertension, and postoperative complications compared to White patients. Minority patients were also more likely to undergo outpatient surgery and had shorter hospital stays. These findings highlight racial disparities in RRM, emphasizing the need for interventions aimed at achieving equitable healthcare access and improving postoperative outcomes for minority populations. Background: Risk-reducing mastectomy (RRM) significantly lowers breast cancer risk as a preventive surgery. While racial disparities in breast cancer treatment are well-documented, research on racial differences in the utilization and outcomes of RRM is limited. Methods: We retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program (2008-2022) to identify women who underwent RRM. Patient demographics, comorbidities, surgical characteristics, and 30-day postoperative outcomes were compared between White and racial minority patients, including Black/African American women. Results: Among 1,285 patients, 88% (n = 1,126) self-identified as White and 12.4% (n = 159) as racial minorities, including 5.8% (n = 74) Black. Minority patients were younger than White patients (50.7 +/- 11.4 years vs. 52.6 +/- 12.6 years; P = .66). Black patients had a significantly higher mean BMI than White patients (33.6 +/- 8.4 kg/m(2) vs. 30.6 +/- 8.0 kg/m(2); P = .03), and higher prevalence of obesity (65%, n = 48 vs. 47%, n = 524; P = .03) and hypertension (51%, n = 38 vs. 30%, n = 342; P = .007). Racial minority patients were more likely to undergo outpatient surgery (81%, n = 129 vs. 57%, n = 645; P < .001) and had shorter hospital stays than White patients (0.8 +/- 1.3 days vs. 1 +/- 2 days; P = .001). Black patients experienced higher rates of superficial incisional infections (9.5%, n = 7 vs. 2.9%, n = 33; P = .18) and overall complications (18%, n = 13 vs. 10%, n = 113; P = .48) Conclusion: This multi-institutional study reveals racial disparities in RRM, with minority patients significantly more likely to present with comorbidities and experience higher complication rates. These findings underscore the need for targeted strategies to ensure equitable access to RRM and improve outcomes for minority patients, advancing health equity in breast cancer prevention.