M. Morrow et al., Factors influencing the use of breast reconstruction postmastectomy: A National Cancer Database study, J AM COLL S, 192(1), 2001, pp. 1-8
BACKGROUND: Advances in surgical techniques and changes in our understandin
g of the biology of breast cancer have made immediate or early breast recon
struction a viable option for the majority of women with breast cancer. Lit
tle is known about national patterns of use of reconstruction. This study w
as undertaken to determine national patterns of care and factors that influ
ence the use of breast reconstruction.
STUDY DESIGN: A large convenience sample reported to the National Cancer Da
ta Base was studied. Patients coded as undergoing mastectomy between 1985 a
nd 1990 (n = 155,463) and between 1994 and 1995 (n = 68,348) were evaluated
. The use of reconstruction in the two time periods was compared, and patie
nt and tumor factors influencing the use of the procedure were compared.
RESULTS: Between 1985 and 1990, 3.4% of mastectomy patients had early or im
mediate reconstruction, increasing to 8.3% in 1994-5. Patient age, income,
geographic location, type of hospital where treatment occurred, and tumor s
tage all influenced the use of reconstruction in univariate analysis. In mu
ltivariate analysis, patients age 50 or under had a 4.3-fold greater likeli
hood of having reconstruction than their older counterparts. Patients with
ductal carcinoma in situ were twice as likely as those with invasive cancer
to have reconstruction. Family income of $40,000 or more (Odds Ratio 2.0),
ethnicity other than African-American (Odds Ratio 1.6), surgery in a Natio
nal Cancer Institute-designated cancer center (Odds Ratio 1.4), and surgery
in a geographic region other than the Midwest or South (Odds Ratio 1.3) re
mained significant predictors of the use of reconstruction in multivariate
analysis.
CONCLUSIONS: Breast reconstruction is an underused option in breast cancer
management. Predictors of the use of reconstruction do not reflect contrain
dications to the procedure, and indicate the need for both physician and pa
tient education. (J Am Coll Surg 2001;192:1-8. (C) 2001 by the American Col
lege of Surgeons).