December 24, 2007
U-M Health Minute: Todayís top health issues and medical research
Most breast cancer surgeons donít talk to patients about reconstruction options, U-M study finds
Women more likely to choose mastectomy after discussing reconstruction
ANN ARBOR, MI – Only a third of patients with breast cancer discussed breast reconstruction options with their surgeon before their initial surgery, according to a new study from the University of Michigan Comprehensive Cancer Center.
What’s more, women who did discuss reconstruction up front were four times more likely to have a mastectomy compared to those women who did not discuss reconstruction.
“The surgical decision making for breast cancer is really centered on patient preference. Long-term outcomes are the same regardless of whether a woman is treated with a lumpectomy or a mastectomy. But that choice could have significant impact on a woman’s quality of life, sexuality and body image. It’s important for women to understand all of their surgical options – including breast reconstruction – so they can make the best choice for themselves,” says study author Amy Alderman, M.D., M.P.H., assistant professor of plastic surgery at the U-M Medical School.
The study appears Dec. 21 in the online version of the journal Cancer, and will appear in the Feb. 1 print edition.
The study looked at 1,178 women from the Detroit and Los Angeles metropolitan areas who had undergone surgery for breast cancer. Patients were contacted about three months after diagnosis and were asked whether they had discussed breast reconstruction with their surgeon before their surgery. Patients were also asked whether knowing about reconstruction options affected their decision to receive a mastectomy.
The researchers found that younger and more educated women were more likely to discuss reconstruction with their surgeon. They also found that this discussion significantly affected a woman’s treatment decision, with women who knew about reconstruction options four times more likely to choose a mastectomy.
Breast reconstruction can be performed immediately after a mastectomy, which removes the entire breast. This type of reconstruction leads to better aesthetic outcomes and psychological benefits for the patient, compared to delayed reconstruction, previous studies have shown.
“To many women, breast reconstruction is a symbol of hope that they can get past this cancer diagnosis. Reconstruction is not necessarily the right option for every woman and not everyone is going to choose reconstruction, but I think it’s important that every woman is informed of what the benefits of reconstruction can be for their physical and emotional well being,” Alderman says.
The researchers urge general surgeons to include discussion of all surgical options – lumpectomy, mastectomy and mastectomy with reconstruction – at a point when a patient is considering her choices. General surgeons could refer patients to plastic surgeons to discuss options before the initial surgery. Decision aids should also incorporate information about reconstruction, the researchers write.
“Patients need to be educated consumers of their health care. If a physician does not bring up an option, the patient needs to ask. She needs to either ask the physician to provide the information or ask for a referral to a specialist who can provide the information. Women need to be proactive about their health care,” Alderman says.
Some 180,000 Americans will be diagnosed with breast cancer this year. For information about treatment options, visit mcancer.org or call the U-M Cancer AnswerLine at 800-865-1125.
In addition to Alderman, study authors were Sarah T. Hawley, Ph.D., U-M Medical School and Ann Arbor VA Health Care System; Jennifer Waljee, M.D., U-M Medical School; Mahasin Mujahid, Ph.D., U-M School of Public Health; Monica Morrow, M.D., Fox Chase Cancer Center; and Steven J. Katz, M.D., M.P.H., U-M Medical School and Ann Arbor VA Health Care System.
Funding for the study was from the National Cancer Institute.
Reference: Cancer, published online Dec. 21, 2007; print issue date: Feb. 1, 2008.
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