Better Communication Linked To Reduced Racial Disparities in Breast Reconstruction Surgery Interview with:

Elham Mahmoudi, PhD, MS Section of Plastic Surgery, University of Michigan Medical School Ann Arbor, Michigan

Dr. Mahmoudi

Elham Mahmoudi, PhD, MS
Section of Plastic Surgery, University of Michigan Medical School
Ann Arbor, Michigan What is the background for this study? What are the main findings?

Response: About one-third of all women diagnosed with breast cancer undergo mastectomy. In recent years, owing to advancements in screening and treatment, life expectancy after being diagnosed with breast cancer has increased. Research has shown that for patients who undergo mastectomy, breast reconstruction offers many psychological benefits such as improved self-esteem, reduced sexual dysfunction, decreased anxiety, and overall improvement in quality of life. After the passage of the Women’s Health and Cancer Rights Act in 1998, the coverage of post-mastectomy breast reconstruction (PBR) by any type of health insurance became mandatory. However, there are large and widening racial and ethnic disparities in PBR, with White women having a higher rate of PBR than women from other racial and ethnic groups.

In 2011, the State of New York enacted a law mandating that surgeons advise their patients undergoing mastectomy about available breast reconstruction options, insurance coverage, and referral to a plastic surgeon. We evaluated the effect of this law on racial/ethnic disparities in immediate PBR.

Our results did not show any effect on the overall rate of immediate  post-mastectomy breast reconstruction or on disparities between white and African-American women; however, we found that White-Hispanic and White-other racial/ethnic group disparities in immediate PBR were reduced by 9 and 13 percentage points, respectively. This is a substantial reduction in disparity within only a year after the passage of the law, which demonstrates the importance of physician-patient communication. What should readers take away from your report?

Response: Physician-patient communication is an essential piece of the puzzle if we intend to reduce health inequities in this country. This is particularly important for subspecialty procedures such as PBR, where patients might not be fully aware of the benefits or drawbacks of available options.

Even when doctors and patients speak the same language, however, lack of effective communication is more pronounced among African-American patients than among other minority populations. Part of this might be due to African-American patients’ distrust of the medical system, built over a long history of events such as the Tuskegee Syphilis Study. Because of this existing history, addressing effective physician-patient communication for this population in a short time period might be challenging. That might explain why we did not find any effect on White/African-American disparity in immediate PBR. What recommendations do you have for future research as a result of this study?

Response: In general, creating effective communication and building rapport and trust between physicians and patients are the first steps in developing a patient-centered approach toward care. Research shows that minority patients and patients with lower socioeconomic status spend less time with their physicians, ask fewer questions, and build less rapport. Although it is hard to measure effective physician-patient communication, I would like to see more research on this topic. Is there anything else you would like to add?

Response: No disclosures. The only thing I would like to add is that I have a lot of respect for Dr. Evan Garfein, MD, from the Montefiore Medical Center in Bronx, New York, who authored the bill that was enacted in 2011 in New York State. People benefit when researchers and policy makers work together to reduce inequity and improve the quality of care. Thank you for your contribution to the community.


Mahmoudi E, Lu Y, Metz AK, Momoh AO, Chung KC. Association of a Policy Mandating Physician-Patient Communication With Racial/Ethnic Disparities in Postmastectomy Breast Reconstruction. JAMA Surg. Published online May 31, 2017. doi:10.1001/jamasurg.2017.0921

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on June 1, 2017 by Marie Benz MD FAAD