TORONTO – Only a small percentage of Canadian women appear to opt for breast reconstruction following mastectomy, despite the safety of the procedure and its positive effects on a patient’s self-esteem, researchers say.
In a review article in this week’s Canadian Medical Association Journal, Toronto researchers say there is a dearth of data on how many women in the country are currently having reconstructive surgery after mastectomy for breast cancer.
But rates in Canada have been historically low, said principal author Dr. Toni Zhong, a plastic and reconstructive surgeon at Princess Margaret Hospital.
An Ontario study in 1994-95 found a breast reconstruction rate of 7.7 per cent, while a 1991 analysis for Nova Scotia showed 3.8 per cent of women in that province had the procedure.
In contrast, rates were higher in Australia (almost 10 per cent in 1982), Denmark (14 per cent, 1999) and England (16.5 per cent, 2006). In the United States, breast reconstruction rates rose from as low as 3.4 per cent in 1985 to a high of 42 per cent in 1997 at specialized cancer centres.
Use of immediate reconstruction at the same time as mastectomy has also increased in the U.S., in part due to a recommendation by the Commission on Cancer of the American College of Surgeons in 2001 to incorporate the practice in the treatment of early-stage breast cancer.
“All I can say from this review is that this isn’t a topic that has been visited,” said Zhong. “At least in Ontario, this topic hasn’t been visited since the mid-1990s.”
National statistics on breast reconstruction aren’t kept, but Zhong and her colleagues are now trying to gather that information province by province.
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“A lot of us have a hunch that maybe Canada is lagging behind what … (other) high-income countries are doing. But we don’t know.”
Research has shown that breast reconstruction performed at the same time as mastectomy for women with early-stage cancer is a “completely safe practice to do from a cancer perspective and it’s actually a good thing to do for patients because they get benefit from it,” she said.
Zhong said women tell her that having a breast surgically restored enhances their feeling of being whole and feminine.
“And I think when you look down and you don’t have the mastectomy scar and instead you have a fairly normal-looking breast mound, it’s less of a reminder that you went through this cancer treatment.
“It’s a sense that you’ve put this battle behind you.”
At cancer centres like Princess Margaret Hospital, Zhong said there is a concerted effort to identify mastectomy patients who are good candidates for immediate breast reconstruction and offer them the surgery.
“But that’s on an institution basis and we want to see that this uptake is going to be uniform across the country, whether you live in Nova Scotia or Saskatchewan or Ontario, whether you live in a rural place versus an urban place, that shouldn’t matter,” she said.
Zhong said there is a misconception that for older women, it’s not safe to do breast restoration. But she said that’s not true.
“It has to do with their physiological age or how healthy they are. One really healthy, fit 60-year-old is not the same as a 40-year-old who’s diabetic, a smoker, obese. So there are other factors that play into this and make someone a good candidate or not a good candidate.”
Factors that would preclude immediate reconstruction include whether a women will need followup radiation and the stage of cancer at diagnosis. If called for, radiation should be started within three months of mastectomy, but that critical treatment could be delayed if reconstruction healing isn’t complete.
And for women with later-stage breast cancer prescribed radiation and chemotherapy – because of concerns about recurrence – reconstruction will usually be postponed for at least two years, she said.
Zhong said once researchers have a better sense of current breast reconstruction rates across the country, the next step would be for medical experts to develop national guidelines outlining which patients are good candidates for the surgery and would benefit most.
“Once we decide that, then all women, whether you live in Thunder Bay or live in downtown Toronto should know about these guidelines. And I think that’s the best way to make this uniform across the board.”
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