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

  1. Amy K. Alderman MD, MPH1,2,§,*,
  2. Sarah T. Hawley PhD2,3,
  3. Jennifer Waljee MD4,
  4. Mahasin Mujahid PhD5,
  5. Monica Morrow MD6,
  6. Steven J. Katz MD, MPH2,3

Article first published online: 21 DEC 2007

DOI: 10.1002/cncr.23214

Issue

Cancer

Cancer

Volume 112, Issue 3, pages 489–494, 1 February 2008

Additional Information

How to Cite

Alderman, A. K., Hawley, S. T., Waljee, J., Mujahid, M., Morrow, M. and Katz, S. J. (2008), Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer. Cancer, 112: 489–494. doi: 10.1002/cncr.23214

Author Information

  1. 1

    Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan

  2. 2

    Veterans Administration Center for Practice Management and Outcomes Research, Ann Arbor VA Health Care System, Ann Arbor, Michigan

  3. 3

    Division of General Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan

  4. 4

    Robert Wood Johnson Clinical Scholars Program and the Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan

  5. 5

    Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan

  6. 6

    Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania

  1. §

    Fax: (734) 763-5354

*Plastic and Reconstructive Surgery, University of Michigan, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0340

  1. †

    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.

  2. ‡

    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.

  3. §

    Fax: (734) 763-5354

Publication History

  1. Issue published online: 18 JAN 2008
  2. Article first published online: 21 DEC 2007
  3. Manuscript Accepted: 24 AUG 2007
  4. Manuscript Revised: 21 AUG 2007
  5. Manuscript Received: 19 JUL 2007

Funded by

  • National Cancer Institute. Grant Number: RO1 CA8837-A1
  • National Cancer Institute
  • National Institutes of Health
  • Department of Health and Human Services. Grant Numbers: N01-PC-35139, N01-PC-65064

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Keywords:

  • breast reconstruction;
  • breast cancer;
  • SEER;
  • decision-making

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.

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