Most women who undergo mastectomy face a decision: whether to have breast reconstruction. Recent studies by City of Hope researchers hint at some factors related to their choice: their age and race, as well as access to health insurance and advanced hospital facilities.

Breast surgeon Laura Kruper, M.D., director of the Rita Cooper Finkel and J. William Finkel Women’s Health Center, and colleagues recently studied reconstruction rates after mastectomy for invasive breast cancer and ductal carcinoma in situ. The studies were published in the Annals of Surgical Oncology in August and October 2011.

The scientists gathered information about nearly 16,000 women treated for breast cancer in four Southern California counties from 2003 to 2007, using data from the California Office of Statewide Health Planning and Development. They wanted to know how likely women were to get reconstruction after surgery — and what factors contributed to that treatment.

Kruper and her fellow physicians noted that reconstruction is a personal choice. They wanted to understand, however, if there are barriers to some women who desire the surgery.

Rates of reconstruction have climbed steadily in recent years. But the researchers’ August study showed that less than one in three women who underwent mastectomy for invasive breast cancer followed their treatment with breast reconstruction.

Women were less likely to opt for reconstruction after invasive cancer as they got older, they found. Women with private insurance and those treated at teaching hospitals or National Cancer Institutedesignated cancer centers were more likely to receive reconstruction.

Kruper suspects that academic hospitals and cancer centers may have more plastic surgeons on staff to perform reconstructive surgeries. And insurance issues may limit patients’ access to some plastic surgeons.

Race and ethnicity also played a part in reconstruction. African-American, white Latino and Asian patients were significantly less likely to have immediate reconstruction. Racial inequalities related to reconstruction involve multiple factors and are complicated, she said.

The latest study indicates that women who receive mastectomy for ductal carcinoma in situ, or DCIS, are twice as likely to undergo reconstruction as women with invasive breast cancer. DCIS is cancer that is confined to the milk duct and has not spread to surrounding tissue, making it highly curable.

Researchers believe that more women with DCIS who are choosing mastectomy also opt for reconstruction after mastectomy because of that cancer’s early stage, meaning that the stage of the cancer is not a factor limiting in reconstruction. But many of the factors influencing reconstruction as part of treatment for invasive breast cancer also carried over to DCIS, including age, type of hospital and insurance, and race or ethnicity.

Studies are now under way to understand the reasons for women’s choices — and how much access to care and personal factors weigh into the use of breast reconstruction. The researchers will explore relationships to the pathology of women’s cancers to see if cancer stage is a factor. They also hope to study whether other diseases and conditions that accompany older age may contribute.