ONCOLOGY

Reshma Jagsi, M.D., D.Phil., found that rates of reconstruction after breast cancer treatment are rising.

Fresh start

More women receiving breast reconstruction after mastectomy

issue 21 | Spring-Summer 2014

A new study finds that the majority of women who undergo mastectomy for breast cancer go on to get breast reconstruction, a practice that has increased dramatically over time. Researchers found that 46 percent of patients received reconstruction in 1998, but that figure rose to 63 percent by 2007.

"Breast reconstruction has a big impact on quality of life for breast cancer survivors. As we are seeing more women survive breast cancer, we need to focus on long term survivorship issues and ensuring that women have access to this important part of treatment," says study first author Reshma Jagsi, M.D., D.Phil., associate professor of Radiation Oncology at the University of Michigan Comprehensive Cancer Center.

The researchers, from academic medical centers and private practice, looked at insurance claims data from the MarketScan Commercial Claims and Encounters database, a large nationwide employment-based database of medical claims. They identified a total of 20,506 women who had been treated with mastectomy for breast cancer between 1998 and 2007. Results appear in the Journal of Clinical Oncology.

RADIATION A FACTOR

While overall rates of reconstruction increased, women who received radiation therapy were less likely to get reconstruction. This is especially concerning as radiation therapy is increasingly being used after mastectomy as a way to further reduce the risk of the cancer returning in women with more aggressive or advanced disease.

The researchers note that reconstruction is more challenging after radiation, which limits the reconstruction options available for these patients. And often the results are not as good.

"As a growing number of women are eligible for radiation after mastectomy, we have to be aware that this alters those patients' reconstruction options and outcomes. Patients' and physicians' concerns about how best to integrate reconstruction and radiation may be influencing patient decisions. We need to determine the best approach to reconstruction for women who receive radiation," Jagsi says.

GEOGRAPHIC DIFFERENCES

The study also revealed dramatic variation in reconstruction based on geographic region, from a low of 18 percent in North Dakota to a high of 80 percent in Washington, D.C. This was largely associated with the number of plastic surgeons working in each state. Other findings reported include:

  • The rate of bilateral mastectomy increased six-fold between 1998 and 2007.
  • Three-quarters of women receiving bilateral mastectomy also have breast reconstruction.
  • More women are receiving implants rather than autologous reconstruction.

Also In This Article:

Watch a video about a patient's experience with breast reconstruction at U-M.

Dr. Momoh explains breast reconstruction options at U-M.