Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 1;110(2):684-699.
doi: 10.1097/JS9.0000000000000909.

Racial disparities in surgical outcomes after mastectomy in 223 000 female breast cancer patients: a retrospective cohort study

Samuel Knoedler  1   2   3 , Martin Kauke-Navarro  3 , Leonard Knoedler  4   3 , Sarah Friedrich  5 , Dany Y Matar  2 , Fortunay Diatta  3 , Vikram G Mookerjee  3 , Haripriya Ayyala  3 , Mengfan Wu  2   6 , Bong-Sung Kim  7 , Hans-Guenther Machens  1 , Bohdan Pomahac  3 , Dennis P Orgill  2 , P Niclas Broer  8 , Adriana C Panayi  2
Affiliations

Racial disparities in surgical outcomes after mastectomy in 223 000 female breast cancer patients: a retrospective cohort study

Samuel Knoedler et al. Int J Surg. .

Abstract

Background: Breast cancer mortality and treatment differ across racial groups. It remains unclear whether such disparities are also reflected in perioperative outcomes of breast cancer patients undergoing mastectomy.

Study design: The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2021) to identify female patients who underwent mastectomy for oncological purposes. The outcomes were stratified by five racial groups (white, Black/African American, Asian, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander) and included 30-day mortality, reoperation, readmission, surgical and medical complications, and non-home discharge.

Results: The study population included 222 947 patients, 68% ( n =151 522) of whom were white, 11% ( n =23 987) Black/African American, 5% ( n =11 217) Asian, 0.5% ( n =1198) American Indian/Alaska Native, and 0.5% ( n =1018) Native Hawaiian/Pacific Islander. While 136 690 (61%) patients underwent partial mastectomy, 54 490 (24%) and 31 767 (14%) women received simple and radical mastectomy, respectively. Overall, adverse events occurred in 17 222 (7.7%) patients, the largest portion of which were surgical complications ( n =7246; 3.3%). Multivariable analysis revealed that being of Asian race was protective against perioperative complications [odds ratio (OR)=0.71; P <0.001], whereas American Indian/Alaska Native women were most vulnerable to the complication occurrence (OR=1.41; P <0.001). Black/African American patients had a significantly lower risk of medical (OR=0.59; P <0.001) and surgical complications (OR=0.60; P <0.001) after partial and radical mastectomy, respectively, their likelihood of readmission (OR=1.14; P =0.045) following partial mastectomy was significantly increased.

Conclusion: The authors identified American Indian/Alaska Native women as particularly vulnerable to complications following mastectomy. Asian patients experienced the lowest rate of complications in the perioperative period. The authors' analyses revealed comparable confounder-adjusted outcomes following partial and complete mastectomy between Black and white races. Their findings call for care equalization in the field of breast cancer surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flow diagram of the screening and selection process. CPT, Current Procedural Terminology.
Figure 2
Figure 2
Racial comparison of the operative time in partial, simple, and radical mastectomy. Exact numbers and statistical comparisons are provided in the Supplementary Table 1 and 2.
Figure 3
Figure 3
Racial comparison of the length of hospital following the three different types of mastectomy. Exact numbers and statistical comparisons are provided in the Supplementary Table 3 and 4.
Figure 4
Figure 4
Graphical illustration of the results of the multivariable analyses. Table 5 shows the exact numbers.
See this image and copyright information in PMC

References

    1. Arnold M, Morgan E, Rumgay H, et al. Current and future burden of breast cancer: global statistics for 2020 and 2040. Breast 2022;66:15–23. - PMC - PubMed
    1. National Cancer Institute. Surveillance Epidemiology, and End Results (SEER) Program. Cancer Stat Facts: female Breast Cancer. 2023 Accessed September 1, 2023. https://seercancergov/statfacts/html/breast.html
    1. Jatoi I, Sung H, Jemal A. The Emergence of the Racial Disparity in U.S. Breast-Cancer Mortality. N Engl J Med 2022;386:2349–2352. - PubMed
    1. American Cancer Society . Key Statistics for Breast Cancer. 2022. https://wwwcancerorg/cancer/breast-cancer/about/how-common-is-breast-can....
    1. Yedjou CG, Sims JN, Miele L, et al. Health and racial disparity in breast cancer. Adv Exp Med Biol 2019;1152:31–49. - PMC - PubMed