In a recent study by my colleagues at the City of Hope in Duarte, Calif., Laura Kruper, MD, et al., researched reconstruction rates after mastectomy for invasive breast cancer and ductal carcinoma in situ (DCIS). Sixteen-thousand women treated for breast cancer in four Southern California counties from 2003 to 2007 were studied on the likelihood that they would get reconstruction after mastectomy surgery, and interestingly, these factors emerged:
- African American and Latina women were less likely to have immediate reconstruction.
- Older women were less likely to opt for reconstruction.
- Women with early-stage disease or DCIS were more likely to have reconstruction.
- Those treated at teaching hospitals were more inclined to have reconstructive procedures.
- Women with insurance coverage opted more often for completion reconstruction.
The researchers noted that reconstruction is a personal choice. I have personally seen many women with early-stage disease opt for prophylactic mastectomy on the unaffected side and with immediate reconstruction, placed the chance of recurrence front and center in their decision making. Yet I have also seen many patients who choose to tattoo their mastectomy scar(s) with elaborate art and use it as a "new sign" of beauty.
It is interesting to note that in light of healthcare reform and the inability to discriminate against pre-existing conditions or lifetime limits to coverage, this dynamic may change in the future. It is critically important for those of us in navigation to listen to the patient and support the decisions they prefer. I am curious to hear other clinicians' experiences with reconstruction options and what their patients select within the context of their diagnosis.
The City of Hope researchers will be continuing to study possible relationships regarding the pathological stage at the time of diagnosis and observe if this may be an additional factor. Stay tuned.
References:
- Beesley H, Ullmer H, Holcombe C, Salmon P. How patients evaluate breast reconstruction after mastectomy, and why their evaluation often differs from that of their clinicians. J Plast Reconstr Aesthet Surg. 2012 Aug;65(8):1064-71.
- Laura Kruper MD, Alicia Holt MD, Xin Xin Xu BS, Lei Duan MS, Katherine Henderson PhD, Leslie Bernstein PhD, Joshua Ellenhorn MD. Disparities in Reconstruction Rates After Mastectomy: Patterns of Care and Factors Associated with the Use of Breast Reconstruction in Southern California. Breast Oncology Volume 18, Issue 8 / August , 2011.
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