Breast Cancer Surgeons Don't Discuss Reconstruction Options

FRIDAY, Dec. 21 HealthDay News) -- Only a third of breast cancerpatients get to discuss their breast reconstruction options with theirgeneral cancer surgeon before the tumor is removed, new researchfinds.
In the study, more than 70 percent of general surgeons who removed thecancer did not talk over options for reconstruction -- which is typicallydone by a plastic surgeon -- before the woman underwent cancersurgery.
"It's disappointing," said lead researcher Dr. Amy K. Alderman,assistant professor of plastic surgery at the University of MichiganMedical School, Ann Arbor.
These discussions do matter: Women who discussed their options forreconstructing the breast beforehand with their physician were four timesmore likely to have a mastectomy (versus lumpectomy) compared to those whodid not talk about the option, the researchers noted.
Th findings were published online Dec. 21 in Cancer and wereexpected to be published in the journal's Feb. 1 print edition.
Alderman and others contend it's crucial for a woman to understand allsurgical options, and that includes reconstruction, so they can betterchoose the best treatment for them. About 180,000 women will be diagnosedwith breast cancer this year, according to the American CancerSociety.
Long-term outcomes are equal, Alderman said, regardless of whether awoman is treated with lumpectomy or mastectomy. Knowing initially aboutthe option to reconstruct definitely affects a woman's decision, as thestudy showed.
Alderman and her colleagues looked at almost 1,200 women, average age59. The women were diagnosed with breast cancer and lived in the Detroitand Los Angeles areas. All were candidates for either mastectomy orbreast-conserving surgery. They had all undergone breast cancer surgeryand were contacted about three months after their diagnosis.
Alderman's team asked them: Did you discuss reconstruction with yoursurgeon before the cancer surgery?
Just one-third of patients did, with younger, more educated women morelikely to hear about the options from their general surgeon. Those withlarger tumors were also more likely to hear about reconstruction options.
The operation to reconstruct a breast can be done right aftermastectomy, in which the entire breast is removed, or it can be delayed.Immediate reconstruction offers a better cosmetic outcome and ispsychologically better, Alderman said.
"It's helpful if they know all their options at that initialdecision-making process," Alderman said. "There's no right or wronganswer."
Women will choose their course, she said, based on a number of factors,including their fear of cancer recurrence, their body image, and otherfactors.
"What we need to get across to consumers is, they need to be educatedconsumers of their own health care," Alderman said. If the surgeon doesn'tbring up the topic of reconstruction, a woman should, she said, and thesooner the better.
The study didn't delve into why the surgeons didn't talk about thereconstruction option or refer the women to plastic surgeons. But Aldermansuspected the "hassle" factor may play a role. The general surgeon mustmake sure, she said, that the women get in to see the surgeon who will dothe reconstruction in a timely manner. "And then the general surgeon andthe plastic surgeon have to coordinate their operating room schedules,"she said.
Women themselves may be so focused on eliminating the cancer that theydon't even broach the topic of reconstruction, Alderman said.
Another expert agreed that the small number of surgeons who initiallydiscussed the reconstruction option was surprising.
"It's very sad that that so few surgeons are sending women forreconstructive appointments," said Dr. Mehra Golshan, director of BreastSurgical Services at the Dana-Farber/Brigham and Women's Cancer Center,Boston, who reviewed the study.
An initial meeting with a surgeon who does reconstruction will providea woman with information on all options, "even if they decide to do[reconstruction] down the road," he said.
Like Alderman, Golshan couldn't say for sure why such a low number ofsurgeons referred their breast cancer patients to plastic surgeons forreconstruction discussions, but he speculated on a few possible reasons."They may think complication rates are too high with immediatereconstruction," he said.
In truth, Golshan said, complications can be higher with immediatereconstruction if post-mastectomy radiation is required. "But not always,"he said. And, "when there is no post-mastectomy radiation, thecomplications rates are equal between immediate reconstruction anddelayed."
It's also possible that surgeons may be so focused on cancerelimination that they may not think about referring the patients forreconstruction information, Golshan added.