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Breast Cancer Surgeons Don't Discuss Reconstruction Options

But these discussions greatly impact women's surgery choices, experts say

FRIDAY, Dec. 21 HealthDay News) -- Only a third of breast cancer patients get to discuss their breast reconstruction options with their general cancer surgeon before the tumor is removed, new research finds.

In the study, more than 70 percent of general surgeons who removed the cancer did not talk over options for reconstruction -- which is typically done by a plastic surgeon -- before the woman underwent cancer surgery.

"It's disappointing," said lead researcher Dr. Amy K. Alderman, assistant professor of plastic surgery at the University of Michigan Medical School, Ann Arbor.

These discussions do matter: Women who discussed their options for reconstructing the breast beforehand with their physician were four times more likely to have a mastectomy (versus lumpectomy) compared to those who did not talk about the option, the researchers noted.

Th findings were published online Dec. 21 in Cancer and were expected to be published in the journal's Feb. 1 print edition.

Alderman and others contend it's crucial for a woman to understand all surgical options, and that includes reconstruction, so they can better choose the best treatment for them. About 180,000 women will be diagnosed with breast cancer this year, according to the American Cancer Society.

Long-term outcomes are equal, Alderman said, regardless of whether a woman is treated with lumpectomy or mastectomy. Knowing initially about the option to reconstruct definitely affects a woman's decision, as the study showed.

Alderman and her colleagues looked at almost 1,200 women, average age 59. The women were diagnosed with breast cancer and lived in the Detroit and Los Angeles areas. All were candidates for either mastectomy or breast-conserving surgery. They had all undergone breast cancer surgery and were contacted about three months after their diagnosis.

Alderman's team asked them: Did you discuss reconstruction with your surgeon before the cancer surgery?

Just one-third of patients did, with younger, more educated women more likely to hear about the options from their general surgeon. Those with larger tumors were also more likely to hear about reconstruction options.

The operation to reconstruct a breast can be done right after mastectomy, in which the entire breast is removed, or it can be delayed. Immediate reconstruction offers a better cosmetic outcome and is psychologically better, Alderman said.

"It's helpful if they know all their options at that initial decision-making process," Alderman said. "There's no right or wrong answer."

Women will choose their course, she said, based on a number of factors, including their fear of cancer recurrence, their body image, and other factors.

"What we need to get across to consumers is, they need to be educated consumers of their own health care," Alderman said. If the surgeon doesn't bring up the topic of reconstruction, a woman should, she said, and the sooner the better.

The study didn't delve into why the surgeons didn't talk about the reconstruction option or refer the women to plastic surgeons. But Alderman suspected the "hassle" factor may play a role. The general surgeon must make sure, she said, that the women get in to see the surgeon who will do the reconstruction in a timely manner. "And then the general surgeon and the plastic surgeon have to coordinate their operating room schedules," she said.

Women themselves may be so focused on eliminating the cancer that they don't even broach the topic of reconstruction, Alderman said.

Another expert agreed that the small number of surgeons who initially discussed the reconstruction option was surprising.

"It's very sad that that so few surgeons are sending women for reconstructive appointments," said Dr. Mehra Golshan, director of Breast Surgical 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 provide a 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 of surgeons referred their breast cancer patients to plastic surgeons for reconstruction discussions, but he speculated on a few possible reasons. "They may think complication rates are too high with immediate reconstruction," he said.

In truth, Golshan said, complications can be higher with immediate reconstruction if post-mastectomy radiation is required. "But not always," he said. And, "when there is no post-mastectomy radiation, the complications rates are equal between immediate reconstruction and delayed."

It's also possible that surgeons may be so focused on cancer elimination that they may not think about referring the patients for reconstruction information, Golshan added.

More information

To learn more about breast reconstruction, visit the American Society of Plastic Surgeons.

SOURCES: Mehra Golshan, M.D., director, Breast Surgical Services, Dana-Farber/Brigham and Women's Cancer Center, Boston; Amy Alderman, M.D., M.P.H., assistant professor, plastic surgery, University of Michigan Medical School, Ann Arbor; Feb. 1, 2008, Cancer

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