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Do women have access to breast reconstruction?

Doctor holding X-ray film and woman in pink braFewer than half of women who undergo mastectomy for breast cancer have breast reconstruction. A new study from the University of Michigan Comprehensive Cancer Center finds 42% of women who were surveyed had breast reconstruction.

The study, published in JAMA Surgery, looked at 485 women treated with mastectomy for breast cancer, following up with them an average of four years after their diagnosis.

“For the most part, women were satisfied with how they made their decision whether to have breast reconstruction. But we also saw that some patients are not getting the information they need to make an informed decision,” says study author Steven Katz, M.D., M.P.H., professor of internal medicine and health policy at the University of Michigan.

Some of the reasons that women in the study cited for not having reconstruction include:

  • Not wanting additional surgery
  • Feeling that reconstruction was not important
  • Concern about possible complications
  • Reluctance to take time away from work or family

“These are all legitimate concerns that must be factored into each individual patient’s decision to pursue reconstruction. Some people think the rate of breast reconstruction is too low. We will never see 100% of women choose breast reconstruction, but we do want to make sure those who want it have access,” says study author Sarah Hawley, Ph.D., associate professor of internal medicine at U-M.

The researchers found that the proportion of breast cancer patients who undergo breast reconstruction has remained relatively stable over time. Also, four years after diagnosis, only 11% of patients who had not undergone reconstruction were still considering it.

One concern is that a significant amount of women also cited misinformation and misconceptions as reasons not to have breast reconstruction:

  • Lack of knowledge about the procedure
  • Fear of implants (they’ve been proven safe)
  • Potential interference with cancer detection (there’s no evidence of this)
  • Insurance barriers (universal coverage of reconstruction after mastectomy is federally mandated)

“It’s essential that women get accurate information and enough time to understand this important decision about breast reconstruction. Plastic surgeons must be part of the initial treatment conversation. We also need better education around the safety of breast implants and the effect of reconstruction on follow-up care,” Katz says.

Katz leads a group called the Cancer Surveillance and Outcomes Research Team, or CanSORT, which is working to develop a tool to help people newly diagnosed with breast cancer understand their treatment options and, in consultation with their doctor, make the best choice for their care.

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Steven KatzThe Cancer Surveillance and Outcomes Research Team, or CanSORT, is an interdisciplinary group of investigators based at the University of Michigan and the Ann Arbor VA Center for Clinical Management Research, with investigators at five universities and cancer centers throughout the United States. CanSORT studies the quality of cancer care across the continuum of care from prevention to survivorship. The team also develops and evaluates interventions to improve cancer care including decision tools for patients and clinicians and dissemination strategies to more quickly move research results to the provider community.

University of Michigan Comprehensive Cancer CenterThe University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan according to U.S. News & World Report. Our multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.