Access to Breast Cancer Treatment and Reconstruction in Rural Populations: Do Women Have a Choice?

Background: Federal law mandates complete insurance coverage for breast reconstruction and considers it an “essential” aspect of breast cancer treatment, on par with mastectomy and chemotherapy. Unfortunately, a significant proportion of women do not undergo reconstruction. The objective of this study is to assess care gaps in breast cancer treatment and reconstruction in rural populations. Methods: All hospitals in Upstate New York were surveyed regarding what components of breast cancer care they provide, including breast surgery, medical oncology, radiation oncology, and plastic surgery. Survey results were correlated with population data to determine how many women might be impacted by geographic barriers to care. Results: Of 135 hospitals, only 56% offered any component of breast cancer treatment, while 30% offer breast surgery, 44% offer radiation oncology, and 42% offer plastic surgery. Microsurgical breast reconstruction was offered at just 14% of hospitals. Only 11% of hospitals were complete cancer care centers, which offer all the essential elements of breast cancer care (breast surgery, reconstructive surgery, medical oncology, and radiation) and all reconstructive options (including microvascular). Based on population data, 21% of Upstate New Yorkers live in counties without access to any form of breast reconstruction, 44% live in counties without microsurgical reconstruction, 30% live in counties without a hospital that staffs all members of the cancer care team, and 47% live in counties without a complete cancer care center. Conclusions: Geographic barriers play a large role in the lack of access to breast cancer care and reconstruction.