Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer

Authors

  • Amy K. Alderman MD, MPH,

    Corresponding author
    1. Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan
    2. Veterans Administration Center for Practice Management and Outcomes Research, Ann Arbor VA Health Care System, Ann Arbor, Michigan
    • Plastic and Reconstructive Surgery, University of Michigan, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0340
    Search for more papers by this author
    • Fax: (734) 763-5354

  • Sarah T. Hawley PhD,

    1. Veterans Administration Center for Practice Management and Outcomes Research, Ann Arbor VA Health Care System, Ann Arbor, Michigan
    2. Division of General Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
    Search for more papers by this author
  • Jennifer Waljee MD,

    1. Robert Wood Johnson Clinical Scholars Program and the Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan
    Search for more papers by this author
  • Mahasin Mujahid PhD,

    1. Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
    Search for more papers by this author
  • Monica Morrow MD,

    1. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Steven J. Katz MD, MPH

    1. Veterans Administration Center for Practice Management and Outcomes Research, Ann Arbor VA Health Care System, Ann Arbor, Michigan
    2. Division of General Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
    Search for more papers by this author

  • The collection of cancer incidence data used in this publication was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885.

  • The ideas and opinions expressed herein are those of the author, and no endorsement by the State of California, Department of Health Services is intended or should be inferred.

Abstract

BACKGROUND.

Reconstruction is rarely incorporated into the decision-making process for surgical breast cancer treatment. We examined the importance of knowing about reconstruction to patients' surgical decision-making for breast cancer.

METHODS.

We surveyed women aged ≤79 years with breast cancer (N = 1844) who were reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results (SEER) cancer registries (response rate, 77.4%). The dependent variables were 1) patients' report of having a discussion about breast reconstruction with their general surgeon (yes/no), 2) whether or not this discussion had an impact on their willingness to be treated with a mastectomy (yes/no), and 3) whether the patient received a mastectomy (yes/no). The independent variables included age, race, education, tumor size, tumor behavior, and presence of comorbidities. Chi-square, Student t test, and logistic regression were used for analyses.

RESULTS.

Only 33% of patients had a general surgeon discuss breast reconstruction with them during the surgical decision-making process for their cancer. Surgeons were significantly more likely to have this discussion with younger, more educated patients with larger tumors. Knowing about reconstructive options significantly increased patients' willingness to consider a mastectomy (OR, 2.06; P <.01). In addition, this discussion influenced surgical treatment. Patients who discussed reconstruction with their general surgeon were 4 times more likely to receive a mastectomy compared with those who did not (OR, 4.48; P < .01).

CONCLUSIONS.

Most general surgeons do not discuss reconstruction with their breast cancer patients before surgical treatment. When it occurs, this discussion significantly impacts women's treatment choice, making many more likely to choose mastectomy. This highlights the importance of multidisciplinary care models to facilitate an informed surgical treatment decision-making process. Cancer 2008. © 2007 American Cancer Society.

Ancillary