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Choosing mastectomy or not: Studying young women's surgical choices
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In a new study examining disparities in postmastectomy breast
reconstruction, researchers at Brigham and Women’s Hospital (BWH) and
Dana-Farber Cancer Institute (DFCI) in Boston, Mass., concluded that
lack of patient-provider discussion may contribute to socioeconomic, age
and race-related inconsistencies in the use of breast reconstruction
after mastectomy. However, the study also found that reconstruction was
more likely to occur after the surgeon discussed options with the
patient, suggesting that efforts are required to increase and improve
these conversations. The full study appears in the April issue of the Journal of the American College of Surgeons.
Breast reconstructive surgery is an expensive elective procedure, but
for many women it is a vital component of surgical care for breast
cancer. The choice to have breast reconstruction is a complex decision
that is influenced by access to care, patient preference and the
provider’s interaction with the patient.
"Patient preferences should be respected, but an informative
discussion of reconstruction is required to help patients understand and
weigh the risks and benefits of this procedure," said Caprice C. Greenberg, MD,
instructor of Surgery in the Center for Surgery and Public Health at
BWH and the Center for Outcomes and Policy Research at DFCI. "We learned
that physicians need to improve communications with patients and
whenever possible, universally address the issue of reconstruction with
all women undergoing a mastectomy, regardless of age, race or
Using the National Initiative on Cancer Care Quality database,
researchers evaluated 626 patients who underwent mastectomy for breast
cancer. The data had been collected in a study commissioned by the
American Society of Clinical Oncology (ASCO) and undertaken by
researchers at the Rand Corporation and the Harvard School of Public
Health. Researchers reviewed data collected via survey and chart review
approximately four years after diagnosis of breast cancer. Of these
patients, 253 (40.4 percent) received breast reconstruction, and 249
(39.8 percent) had medical records documenting the occurrence of a
discussion about this option.
"The data from the NICCQ study are continuing to reveal important opportunities to improve cancer care," said ASCO President Nancy Davidson, MD,
professor of oncology and breast cancer research chair at the Sidney
Kimmel Cancer Center at Johns Hopkins University in Baltimore. "As
oncologists, we need to be sure that we are thoroughly communicating
with patients about all of their options for care."
Approximately 70 percent of patients who had a documented discussion
about breast reconstruction with their provider underwent the procedure.
However, researchers found that increasing age and lower levels of
education were associated with lower rates of a documented discussion.
Hispanic patients, patients born outside the United States and those
whose primary language was not English were less likely to actually
receive reconstruction once the procedure was discussed.
Based on these results, the study authors suggest that physicians
should systematically address the issue of reconstruction with all
patients undergoing mastectomy, including why she is or is not a
candidate. They also recommend optimizing physician-patient discussions
by using interpreters and appropriate educational materials to ensure an
informative conversation regardless of primary language, ethnicity, or
The American College of Surgeons is a scientific and educational
organization of surgeons that was founded in 1913 to raise the standards
of surgical practice and to improve the care of the surgical patient.
The College is dedicated to the ethical and competent practice of
surgery. Its achievements have significantly influenced the course of
scientific surgery in America and have established it as an important
advocate for all surgical patients. The College has more than 72,000
members and is the largest organization of surgeons in the world. For
more information, visit www.facs.org.