Disparities in Breast Reconstruction After Mastectomy in Southeast Asia: A Systematic Review.

IF 2 3区 医学 Q3 ONCOLOGY Journal of Surgical Oncology Pub Date : 2024-12-10 DOI:10.1002/jso.28014
Antoinette Nguyen, Jeewon Chon, Brigid Coles, Robert Galiano
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Abstract

Breast cancer is the most commonly diagnosed cancer among women in Southeast Asia. However, significant disparities in access to postmastectomy breast reconstruction persist due to cultural, economic, and healthcare-related factors. These disparities result in unequal access to care, impacting patient outcomes, and overall quality of life. A systematic review was conducted following PRISMA guidelines to assess trends, disparities, and outcomes in breast reconstruction across Southeast Asia. The review included 15 studies published between 2000 and 2023 from countries including Singapore, Malaysia, Vietnam, Thailand, and Brunei. Data extracted focused on disparities related to ethnicity, socioeconomic status, geographic location, and surgical outcomes. Statistical analysis included summarizing key variables across studies. Significant cultural and economic barriers to breast reconstruction were identified. Cultural beliefs influenced uptake, with Malay women preferring autologous tissue reconstruction (92.3%), while Chinese women had lower reconstruction rates due to traditional beliefs. Economic constraints limited access to advanced techniques like the DIEP flap, which had a median cost of SGD 11 009.38, significantly higher than the TRAM flap (SGD, 300.51, p < 0.001). Geographic disparities further restricted access, especially in rural areas. Complication rates were higher in obese patients, with total flap loss at 6% and fat necrosis at 10%. Studies from Vietnam and Thailand reported 5-year overall survival rates of 95% and disease-free survival rates of 80.7% for early-stage breast cancer patients undergoing reconstruction. Breast reconstruction disparities in Southeast Asia are driven by complex interactions between cultural, economic, and healthcare-related factors. Efforts to reduce these disparities must focus on increasing patient education, expanding reconstructive options, and addressing systemic healthcare inequalities. Targeted interventions, including policy changes to subsidize reconstruction and improve surgeon training in rural areas, are critical to ensuring equitable access and improving patient outcomes across the region.

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来源期刊
CiteScore
4.70
自引率
4.00%
发文量
367
审稿时长
2 months
期刊介绍: The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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