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Few Women Get Breast Reconstruction After Mastectomy: Study

By Kathleen Doheny
HealthDay Reporter

THURSDAY, Dec. 8 (HealthDay News) -- Few women undergo breast reconstruction after a mastectomy, despite the known cosmetic and psychological advantages, a new study indicates.

"The immediate reconstruction rates are higher in women with DCIS (ductal carcinoma in situ, an early stage cancer) than with invasive cancer," said Dr. Dawn Hershman, an associate professor of medicine and epidemiology at Columbia University Medical Center, in New York City.

Fewer than one in four women with invasive cancer opts for the immediate reconstruction of their breast, she found. More than one in three with early stage cancer got the procedure.

Hershman and her colleagues evaluated discharge data from a database representing 15 percent of U.S. hospitals. They found 108,992 women with invasive breast cancer who underwent a mastectomy and 14,710 women with early stage cancer who did.

From 2000 to 2010, 23.4 percent of those women with invasive cancers got immediate reconstruction and 36.4 percent of those with early stage cancers did.

Those most likely to get it were women younger than age 50 who had commercial health insurance. For those women, the rate of reconstruction in 2010 was 67.5 percent. Along with older women, Hershman found blacks and rural residents were less likely to get reconstruction.

Insurance was the biggest predictor of whether the women got immediate reconstruction. The procedure is covered by Medicare, Medicaid and private insurance, although there is sometimes a co-pay.

That out-of-pocket charge may be a stumbling block. "The cost of mastectomy has remained stable," Hershman said of the last decade. "But the cost of reconstruction has increased nearly threefold over this decade."

She presented the findings Thursday at the San Antonio Breast Cancer Symposium. The Cancer Therapy & Research Center at The University of Texas Health Science Center at San Antonio, the American Association for Cancer Research and Baylor College of Medicine are joint sponsors of the meeting.

In reconstructing the breast, a surgeon rebuilds the breast's shape, using several techniques such as implants or repositioning a woman's own tissue.

Public policy makers should address the issue, the study authors said, and ensure access to reconstruction for all women who desire it. Hershman acknowledged that some women may bypass the offer for reconstruction, for a variety of reasons, such as financial and personal.

The findings are surprising, said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital, in New York City.

She acknowledged that some women decline the reconstruction. "Some choose not to go forward," she said, with some women citing their desire to avoid more surgery. However, she thinks some women may not be aware of the option or they may not be aware of insurance coverage for it. Some who must pay a co-pay may decline for financial reasons, she said.

Previous research by others has found that women without insurance are often not told about the option. "Women have to be made aware that reconstruction is an option," Bernik said. If there is an issue with finances, she said, women should consider asking their doctor about arranging a payment plan.

Immediate reconstruction is now the standard of care, she said. However, in some cases, a reconstructive surgery may be best delayed after certain cancer treatments.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

Visit the American Society of Plastic Surgeons to learn more about breast reconstruction.

SOURCES: Dawn Hershman, M.D., associate professor, medicine and epidemiology, Columbia University Medical Center, New York City; Stephanie Bernik, M.D., chief, surgical oncology, Lenox Hill Hospital, New York City; Dec. 8, 2011, presentation, San Antonio Breast Cancer Symposium

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