ORIGINAL ARTICLE – AMERICAN SOCIETY OF BREAST SURGEONS 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 Laura Kruper 1 , Xinxin Xu 2 , Katherine Henderson, PhD 2 , and Leslie Bernstein 2 1 General and Oncologic Surgery, City of Hope; 2 Population Sciences, City of Hope ABSTRACT Background. Many factors influence whether breast can- cer patients undergo reconstruction after mastectomy. This study was undertaken to determine the patterns of care and variables associated with the use of reconstruction for ductal carcinoma in situ (DCIS) and to compare previous results for invasive carcinoma. Methods. Postmastectomy reconstruction rates were col- lected from the California Office of Statewide Health Planning and Development (OSHPD) for 2003–2007. International Classification of Disease-9 codes were used to identify patients undergoing reconstruction after mastec- tomy. Variations in reconstruction rates were examined by type of breast cancer (DCIS vs. invasive), calendar year, age, type of insurance, type of hospital, and race/ethnicity. Univariate and multivariate odds ratios (OR) with 95% confidence intervals (CI) were estimated for relative odds of immediate reconstruction versus mastectomy only. Results. For multivariate analysis, age, race/ethnicity, type of insurance, and type of hospital were significantly asso- ciated with the use of reconstruction for DCIS patients. DCIS patients were twice as likely to undergo recon- struction as patients with invasive cancer (odds ratio (OR) = 1.93, 95% confidence interval (CI) = 1.75–2.13). DCIS patients with private insurance were nine times more likely to undergo reconstruction as patients with Medicaid (OR = 8.84, 95% CI = 5.92–13.21). Both Hispanic white and Asian patients were one-fifth as likely to undergo reconstruction compared with non-Hispanic white patients (OR = 0.18, 95% CI = 0.1–0.3; OR = 0.17, 95% CI = 0.09–0.31). Conclusions. Postmastectomy rates for DCIS were twice those for invasive cancer mostly because stage was not a limiting factor. However, significant factors remain that limit the use of reconstruction in this breast cancer popu- lation: age, race/ethnicity, type of hospital, and type of insurance. Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer with a favorable prognosis, with mortality rates less than 2% after excision or mastectomy. 1,2 DCIS was rarely diagnosed before 1980, but with the advent of mammo- graphic screening, the incidence has greatly increased to approximately 25% of breast cancers diagnosed in the United States. 3 In 2010, 54,000 women were diagnosed with DCIS compared with 207,000 diagnosed with inva- sive carcinoma. 4 For women with DCIS, the surgical options include breast-conserving surgery (BCS), with or without radiation, or mastectomy. Currently in the United States, the majority of women (69.9%) choose BCS over mastectomy (26.1% unilateral, 4.1% bilateral) for DCIS, with the rates of BCS being higher for women with DCIS than for women with invasive carcinoma (57.8%). 5,6 Even with high survival rates after DCIS diagnosis, some women choose more aggressive surgery for treatment. Influencing the choice behind mastectomy for DCIS are factors, such as limited access to radiation facilities or patient desire to avoid radiation, extensive or multifocal disease, physician opinion, and fear of recurrence. Regarding reconstruction after mastectomy, many studies have documented improved quality of life and patient sat- isfaction for those choosing this option. 7–11 Despite the benefits of postmastectomy reconstruction, its utilization is Ó Society of Surgical Oncology 2011 First Received: 18 April 2011 L. Kruper e-mail: lkruper@coh.org Ann Surg Oncol DOI 10.1245/s10434-011-2010-y