Welcome to CDC Stacks | Access to Breast Reconstruction and Patient Perspectives on Decision Making - 42089 | CDC Public Access
Stacks Logo
Advanced Search
Select up to three search categories and corresponding keywords using the fields to the right. Refer to the Help section for more detailed instructions.
 
 
Help
Clear All Simple Search
Advanced Search
Access to Breast Reconstruction and Patient Perspectives on Decision Making
Filetype[PDF - 347.47 KB]


Details:
  • Pubmed ID:
    25141939
  • Pubmed Central ID:
    PMC4732701
  • Description:
    IMPORTANCE

    Most women having mastectomy for breast cancer treatment do not have breast reconstruction.

    OBJECTIVE

    To examine correlates of reconstruction and determine if there is a significant unmet need for reconstruction.

    DESIGN

    Los Angeles and Detroit SEER registries utilized rapid case ascertainment to identify a sample of women diagnosed with breast cancer. Subjects were surveyed a median of 9mos post-diagnosis initially; those remaining disease-free were surveyed again at 4yrs to determine the frequency of immediate and delayed reconstruction, and patient attitudes toward the procedure.

    SETTING

    Two metropolitan area population-based SEER registries were used to identify subjects; Latina/Black women were oversampled to ensure adequate minority representation.

    PARTICIPANTS

    Women age 20-79 with DCIS and stage 1-3 invasive carcinoma diagnosed between 6/05-2/07 were eligible if they could complete a questionnaire in English or Spanish. Initial survey was sent to 3252 women. 2290 completed it. 1536 completed the follow-up survey. The 485 undergoing initial mastectomy and remaining disease-free at follow-up are this report’s subject.

    MAIN OUTCOMES/MEASURES

    Participants were surveyed a mean of 9mos and again at 50mos post-diagnosis. Latina and Black women were oversampled.

    RESULTS

    Response rates in the initial and follow-up surveys were 73% and 68%, respectively (overall, 50%). Of 485 patients reporting mastectomy at initial survey and remaining disease-free, 41.6% had reconstruction—24.8% immediate, 16.8% delayed. Factors significantly associated with not receiving reconstruction were Black race, lower education level, older age, major co-morbidity, and receipt of chemotherapy. Only 13% of women were dissatisfied with reconstruction decision making, but dissatisfaction was higher among non-whites in the sample(p=.032). The most common patient-reported reasons for not having reconstruction were the desire to avoid additional surgery and feeling that it was not important, but 36% expressed fear of implants. Reasons for avoiding reconstruction and systems barriers to care varied by race; barriers were more common among non-whites. Residual demand for reconstruction at 4yrs was low, with only 30/263 non-reconstructed respondents still considering the procedure.

    CONCLUSIONS/RELEVANCE

    Reconstruction rates largely reflect patient demand; most patients are satisfied with reconstruction decision making. Specific approaches are needed to address lingering patient-level and systems factors negatively impacting reconstruction use in minority women.

  • Document Type:
  • Collection(s):
  • Funding:
    K05CA111340/CA/NCI NIH HHS/United States
    R01 CA088370/CA/NCI NIH HHS/United States
    K05 CA111340/CA/NCI NIH HHS/United States
    P30 CA008748/CA/NCI NIH HHS/United States
    R01 CA139014/CA/NCI NIH HHS/United States
    U58 DP000807/DP/NCCDPHP CDC HHS/United States
    R01CA109696/CA/NCI NIH HHS/United States
    N01PC54404/CA/NCI NIH HHS/United States
    R21CA122467/CA/NCI NIH HHS/United States
    N01PC35145/CA/NCI NIH HHS/United States
    R21 CA122467/CA/NCI NIH HHS/United States
    N01PC35139/CA/NCI NIH HHS/United States
    R01 CA109696/CA/NCI NIH HHS/United States
No Related Documents.
You May Also Like: