Factors influencing the use of breast reconstruction postmastectomy: A National Cancer Database study

Citation
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
Citations number
31
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
ISSN journal
10727515 → ACNP
Volume
192
Issue
1
Year of publication
2001
Pages
1 - 8
Database
ISI
SICI code
1072-7515(200101)192:1<1:FITUOB>2.0.ZU;2-E
Abstract
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).