Approximately one third of women with breast cancer will undergo a surgical procedure called a mastectomy to remove one or both breasts as part of their treatment. For those at high risk of developing breast cancer, the procedure is often carried out as a preventative measure. Immediate breast reconstruction (IBR), where the surgeon rebuilds the breast in the same procedure as the mastectomy—sometimes sparing the skin and nipple—is one option to help improve quality of life for breast cancer survivors. However, it has been reported that IBR is under used.
PM Clinical Researcher Dr. Toni Zhong examined procedure information from the Canadian Institute for Health Information (CIHI) database to identify factors that influence the IBR choice and access to the procedure. The team found that patients receiving mastectomy without reconstruction were more likely to come from lower income or immigrant neighbourhoods. Furthermore, the likelihood that the reconstruction procedure was carried out was much higher at teaching hospitals or those institutions where two or more plastic surgeons were on staff, and patients undergoing IBR were more likely to travel longer distances to get the procedure. "As well as socioeconomic factors, the undersupply of plastic surgeons in Ontario may be a factor in the low rates of IBR; only 40 of Ontario's 193 hospital sites met the two or more plastic surgeon criteria," says Dr. Zhong.
This work was supported by the Canadian Breast Cancer Foundation, Cancer Care Ontario, the Institute for Clinical Evaluative Sciences, the Ontario Ministry of Health and Long-Term Care and The Princess Margaret Cancer Foundation.
Barriers to immediate breast reconstruction in the Canadian universal health care system. Zhong T, Fernandes KA, Saskin R, Sutradhar R, Platt J, Beber BA, Novak CB, McCready DR, Hofer SO, Irish JC, Baxter NN. Journal of Clinical Oncology. 2014 July. [PubMed abstract]
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