Few patients in Canada undergo breast reconstruction after mastectomy, despite its safety as a procedure and the positive psychological benefits, states a review article in CMAJ (Canadian Medical Association Journal).
The article reviews rates of breast reconstruction and factors that influence the practice of immediate reconstruction in patients with early stage breast cancer. However, information is lacking on the current rate and factors that influence this procedure in Canada.
Rates in Canada have been historically low, with a reconstruction rate of 7.7% in Ontario (1994/95) and 3.8% in Nova Scotia from 1991. In contrast, rates were higher in Australia (9.9%, 1982), Denmark (14%, 1999) and England (16.5%, 2006). In the United States, rates for breast reconstruction have increased from as low as 3.4% in 1985 to a high of 42% from 1997 in a network of tertiary cancer centres. Use of immediate reconstruction at the same time as mastectomy has also increased in the US, in part due to a recommendation by the Commission on Cancer of the American College of Surgeons in 2001 to incorporate this practice in the treatment of early stage breast cancer.
In general, older age, ethnicity, socioeconomic status and geography affect the use of breast reconstruction. Women older than 50 years are less likely to undergo reconstruction. This may be secondary to concerns of increased complications or comorbidities, although a US study found that the negative relationship between advanced age and decreased breast reconstruction remained significant after controlling for patient comorbidities. Women of lower socioeconomic status were less likely to have reconstruction. Women living in large urban centres were more likely to undergo breast reconstruction. For example, there were 10 reconstructions per 100 mastectomies in the Toronto area compared with 4.3 per 100 mastectomies in the rest of Ontario in 1994/1995. Other modifiable barriers to br
|Contact: Kim Barnhardt|
Canadian Medical Association Journal