Surgeon perspectives on surgical options for early-stage breast cancer

To evaluate the practice patterns of general and plastic surgeons regarding patients with early-stage breast cancer, all general and plastic surgeons in Quebec and Maryland were mailed self-administered questionnaires evaluat ing surgeon demographics, practice patterns, treatment preferences, and sat isfaction with the results of lumpectomy and radiation therapy or breast re construction. Response rates of 38.3 percent and 26.7 percent were obtained for general surgeons in Quebec and Maryland, respectively. The ratio of re ported mastectomies to lumpectomies was 1:2 in Maryland and 1:5 in Quebec. All general surgeons considered lumpectomy an important option. Ninety per cent of Maryland surgeons versus 44 percent of Quebec surgeons considered m astectomy important. A total of 53.6 percent versus 24.9 percent of general surgeons in Maryland and Quebec, respectively, considered delayed reconstr uction an important option. Additionally, 81.3 percent of Maryland surgeons considered immediate reconstruction important, and 79.6 percent discussed it with all stage I or II patients. More than 75 percent of Quebec general surgeons reported discussing immediate or delayed reconstruction with less than or equal to 50 percent of these women. Response rates of 53.6 percent and 48.8 percent were obtained for plastic surgeons in Quebec and Maryland, respectively. In one year Quebec plastic surgeons reported that they perfo rmed less than half the number of reconstructions performed by Maryland pla stic surgeons (7.2 versus 17.3). In Quebec, 82.3 percent of surgeons report ed that they frequently discuss delayed reconstruction, 25.1 percent immedi ate, 62.5 percent pedicled TRAM, and 51.7 percent nonautogenous options. In Maryland, 74.3 percent of plastic surgeons frequently discuss delayed reco nstruction, 95.7 percent immediate, 89.9 percent pedicled TRAM, and 85.9 pe rcent nonautogenous options. For women with early-stage breast cancer, regi onal variations exist in the surgical options discussed and provided.