Despite a rise in the number of patients who received breast
reconstruction after mastectomy, those women are still in the minority.
According to a study by American Society of Breast Surgeons researchers, the
percentage of women undergoing reconstruction increased to less than 30% in
2007.
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| Laura Kruper |
The study found that significant factors in this trend include age,
insurance status, calendar year, race, and the type of treatment facility
involved.
Factor evaluation
The Women’s Health and Cancer Rights Act, passed in 1998, said that
every woman had the right to reconstruction after mastectomy, and this
procedure had to be covered by insurance. Previous studies, however, show that
the passage of this act did not impact or increase reconstruction rates.
Using the Office of Statewide Health and Planning Development in
California database, which provides hospital inpatient data, Laura Kruper, MD,
and her colleagues determined a sample of patients over a 5-year period based
on those who were diagnosed with breast cancer, those who underwent a
mastectomy and those who received reconstructive surgery. They then evaluated
those patients on five factors: age, type of hospital, insurance status, race
and the calendar year in which the patients underwent the surgery.
Kruper, breast cancer surgeon and assistant professor at City of Hope
National Medical Center in Duarte, Calif., found that the percentage of women
who received reconstruction rose during the 5-year period — from 21.4% in
2003 to 29.3% in 2007.
“That was encouraging,” Kruper told O&P Business
News. “This is much better than the 3.5% that was reported in the
mid-1980s.”
Improvement over time
She said this increase is part of the natural evolution of the
procedure.
“In the 1980s, there was concern about whether a reconstructed
breast would interfere with monitoring these patients for recurrence,” she
said. “When that was shown not to be true … the reconstruction rates
started to rise. The rise could be explained in part by an increase in both
provider and patient education.”
Additionally, reconstructive techniques have advanced over time,
providing more options for patients, she said.
One of the strongest variables was insurance status, she said. The
majority of patients who underwent reconstruction had private insurance, while
of women who choose to undergo breast reconstruction after mastectomy is rising, the majority of patients still decide against the procedure.” width=”400″ height=”235″ hspace=”0″ vspace=”0″ border=”1″>
choose to undergo breast reconstruction after mastectomy is rising, the
majority of patients still decide against the procedure.
Care Surgeons
Kruper’s study also showed that black women were half as likely,
and Asian women one-third as likely, as white women to have reconstruction.
Review of prior research, she said, revealed another study that showed that
black women were less likely to be sent for referrals for breast
reconstruction; and then when they were, they were actually less likely to
decide to undergo reconstruction. Clearly, the racial disparities in
reconstruction rates are multifactorial and complicated, she said.
Limited data
Kruper noted that the available data limited the study; researchers
already have begun further studies to collect information regarding the true
reasons behind patients’ decisions — to determine, for example,
patient preference versus limited access to care.
In the meantime, she said she hypothesizes, based on her own practice,
that many women simply elect not to undergo reconstruction for reasons such as
a desire not to have additional surgery, advanced age or a lack of interest in
reconstruction.
“For women who elect to not have reconstruction, breast prostheses
are invaluable,” Kruper said.
In addition, many women undergo delayed reconstructions, where breast
reconstruction is delayed for about a year until after the completion of the
course of radiation.
“Many of these women who have to wait to undergo reconstruction opt
for breast prostheses, at least in my practice, until they have surgery, to
help them with the psychological aspect of losing a breast,” she said.
— by Stephanie Z. Pavlou
Laura Kruper’s study gives clinical credence to what many in the
post-mastectomy profession know anecdotally: that surgical breast
reconstruction is not a simple “either/or” question. Nor is it a
matter of aesthetics or vanity. Multiple factors affect a woman’s decision
and ability to have surgical reconstruction post-mastectomy. The California
Study examined access, but there is also the component for consideration that
many women are physiologically not candidates or not immediate candidates for
the multi-step surgical reconstruction process.
For those women who do not undergo surgical reconstruction, permanent
external breast prostheses are a necessary and lifelong part of the recovery
process. Even for women who choose reconstruction, an interim prosthesis may be
necessary. A certified fitter understands that each of these situations pose
fitting challenges. Whether a woman chooses immediate, delayed or no surgical
reconstruction, post-mastectomy external prostheses are an important part of
the process.
Ultimately Kruper illuminated the need for education of both
practitioners and the community about post-mastectomy treatment options and a
need for the overall understanding of the many and complicated issues faced by
women who survive breast cancer.
— Rhonda F. Turner, PhD, CFm
President,
American Association of Breast Care Professionals and Practitioner Advisory
Council member, O&P Business News
In reading Laura Kruper’s study, I found it interesting to see the numbers of women not choosing reconstruction, about one-third of the patients choose to get reconstruction. As is stated in the article, some of this may be based on the location, age, insurances and preference. For my area, we see a large number of women opting for reconstruction. I have not seen a pattern with regards to age, insurance or race.
As The Women’s Health and Cancer Rights Act states, every woman has the right to reconstruction after a mastectomy. This has also incorporated the coverage criteria for external breast-related products, i.e. breast prosthesis, bras and camisoles.
I find a key factor to any of this is education of the providers, fitters and, most of all, the patients. No matter what the patient’s choice is for treatment, she always has options, whether it is a simple post-mastectomy camisole to hold the drains when she leaves the hospital, either following reconstruction or mastectomy. In my opinion women need to be involved, educated and know what is out there before they make a choice.
— Kimberly Hertz, BOCO, CMF, Cfom
Practice manager, Hanger Prosthetics & Orthotics
