A study published in the May issue of Cancer suggests that low rates of breast-reconstruction surgery in the United States may be due to major differences in plastic surgeon referral practices by general surgeons treating newly diagnosed breast cancer patients.

According to background information in the study, even though the procedure is covered by health insurance, breast reconstruction is done in only 16% of women in the US who have had a mastectomy. Previous research has suggested that age and race are factors in this low rate, and that physicians’ referral and information-sharing habits may also have an impact.

The study of 456 general surgeons in Ann Arbor, Mich, and Los Angeles found that 30% of them refer most of their breast-cancer patients for a breast reconstruction consultation at the time of treatment planning. And 40% of them referred fewer than 30% of their eligible patients to a plastic surgeon for a breast- reconstruction consultation, whereas 20% of the surgeons referred more than 80% of eligible patients.

Female surgeons who performed more than 50 surgeries a year and surgeons with clinical practices located in cancer centers were most likely to refer a high proportion of eligible patients, the study found.

Surgeons with low referral rates cited inadequate patient knowledge, the high cost of reconstruction, and the unavailability of plastic surgeons as reasons for not referring patients for a breast-reconstruction consultation. Many low-referral surgeons also said they believed that breast-cancer patients regarded breast reconstruction as a low priority compared to other aspects of breast-cancer management.

[www.hon.ch, March 26, 2007]