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To the Editor: Despite the quality-of-life benefits of breast reconstruction for women who have undergone mastectomy for breast cancer,¹ less than 20% of eligible patients have this procedure done.² Considerably lower reconstruction rates occur in many geographic regions and in some racial and ethnic groups.² Low utilization has been attributed to nonuniform coverage of breast reconstruction by insurers who viewed the procedure as primarily cosmetic.³ For this reason, the Women's Health and Cancer Rights Act (WHCRA), which mandated insurance coverage of breast reconstruction after mastectomy, was implemented in 1999,⁴ followed in 2001 by additional legislation imposing penalties on noncompliant insurers.⁵ We assessed the impact of the WHCRA on practice patterns related to breast reconstruction.

Methods

All women undergoing mastectomy for breast cancer from 1998 to 2002 were identified using the Surveillance, Epidemiology, and End Results (SEER) program public use data file. The SEER database includes 13 separate state and regional registries . . . [Full Text of this Article]

Amy K. Alderman, MD, MPH
aalder@umich.edu
Health Services Research and Development and Surgical Service
Ann Arbor VA Health Care System
Ann Arbor, Mich

Yongliang Wei, MS; John D. Birkmeyer, MD
Michigan Surgical Collaborative for Outcomes Research and Evaluation
University of Michigan Medical Center
Ann Arbor

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