When breast cancer surgeons regularly confer with plastic
surgeons prior to surgery, their patients are more likely to have
reconstruction, according to a new study led by researchers at the University
of Michigan Comprehensive Cancer Center.
Where a woman goes for breast cancer treatment can vary
widely - ranging from small private practices to large hospital settings. That
choice can impact the type of care a woman receives when it comes to reconstruction.
"Breast reconstruction is a very complex treatment issue
that requires a lot of discussion. Our results suggest that discussion can be
quite different depending on where a patient gets initial treatment," says lead
study author Steven J. Katz, M.D., M.P.H., professor of internal medicine at
the U-M Medical School and of health management and policy at the U-M School of
"Patients with similar characteristics or preferences may
get a different story from different surgeons - and this depends largely on
whether a plastic surgeon is on the treatment decision team from the get-go.
Plastic surgeons are the ones with the expertise to explain the increasingly
complicated procedure options," Katz adds.
Results of the study appear online in the journal Medical
Care and will be published in the October issue.
Researchers from the Cancer Surveillance and Outcomes
Research Team, a multidisciplinary collaboration among five centers across the
country, surveyed breast cancer patients and their surgeons about treatment
They found that use of mastectomy over breast-conserving
lumpectomy varied little by surgeon. Primarily, women who were not eligible for
lumpectomy or who preferred mastectomy received the more aggressive surgery.
This supports previous research by the CanSORT team that shows surgeons
generally are consistent in their approach to mastectomy use.
Reconstruction is another story. About one-third of women
who undergo mastectomy go on to have breast reconstruction. While there are
multiple reasons why a woman might not have reconstruction, this study found
that 31 percent of the variation could be attributed solely to how often the
patient's surgeon talked to a plastic surgeon prior to initial surgery.
"This is a deeply intimate and important decision that women
have to make. It should be made with the right information about reconstruction
options in consultation with a plastic surgeon involved up front in the
treatment planning," says Katz, co-director of the socio-behavioral program at
the U-M Comprehensive Cancer Center.
"Patients should be particularly attentive to engaging
their surgeons on the first visit about this important treatment option."