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Doctor-Patient Talks Affect Use of Breast Reconstruction Surgery

Disparity in practice linked to race, age and socioeconomic status, study finds

FRIDAY, April 11 (HealthDay News) -- A lack of patient-doctor discussion may contribute to socioeconomic, age and race-related disparities in the use of breast reconstruction after mastectomy, says a study by researchers at Brigham and Women's Hospital and the Dana-Farber Cancer Institute in Boston.

The study also found that breast reconstruction was more likely to occur after a surgeon discussed options with a patient, which suggests the need to increase and improve these conversations, the researchers said.

They analyzed data on 626 patients who underwent mastectomy for breast cancer. Of those patients, 253 (40.4 percent) received breast reconstruction, and 249 (39.8 percent) had a documented discussion about the option with a doctor.

About 70 percent of those who had a discussion about breast reconstruction had the procedure. But the researchers found that increasing age and lower levels of education were associated with lower rates of a documented discussion. Hispanic patients, those born outside of the United States, and those whose primary language wasn't English were less likely to undergo reconstruction after discussing it with a doctor.

The study was published in the April issue of the Journal of the American College of Surgeons.

The decision to have breast reconstruction is a complex one that's influenced by access to care, patient preference and a doctor's interaction with the patient, the researchers noted.

"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," Dr. Caprice C. Greenberg, Instructor of Surgery in the Center for Surgery and Public Health at Brigham and the Center for Outcomes and Policy Research at Dana Farber, said in a prepared statement. "We learned that physicians need to improve communications with all women undergoing a mastectomy, regardless of age, race or socioeconomic status."

She and her colleagues said doctors should systematically address the issue of breast reconstruction with all patients undergoing mastectomy. Doctor-patient discussions could include interpreters and educational materials to ensure an informative discussion regardless of a patient's primary language, ethnicity or education level.

More information

The American Cancer Society has more about breast reconstruction after mastectomy.

-- Robert Preidt

SOURCE: American College of Surgeons, news release, April 2, 2008

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