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Post-Mastectomy Breast Reconstruction Rate Remains Low

Study finds little change despite recent law mandating insurance coverage

WEDNESDAY, Jan. 25, 2006 (HealthDay News) -- The number of women choosing breast reconstruction after a mastectomy has not risen much, despite a law mandating medical insurance coverage for the procedure, researchers report.

Fewer than one-fifth of women who undergo mastectomy currently choose to undergo breast reconstruction, the study found. Before medical insurance was mandated for the procedure in 1999, about 15.9 percent of women had the operation to fashion a new breast. During the years 2000 to 2002, 16.8 percent did.

"I was surprised," said lead researcher Dr. Amy Alderman, an assistant professor of surgery at the Ann Arbor VA Health Care System and the University of Michigan at Ann Arbor. She and other experts expected reconstruction rates would rise significantly after the federal Women's Health and Cancer Rights Act (WHCRA) went into effect in 1999. That legislation mandated insurance coverage for reconstruction after a mastectomy.

The report appears in the Jan. 25 issue of the Journal of the American Medical Association.

In their study, Alderman and her team first identified all women undergoing mastectomy for breast cancer from 1998 to 2002, using data from the Surveillance, Epidemiology and End Results (SEER) program. This database includes 13 state and regional registries representing about 26 percent of the U.S. population.

The researchers calculated how many women underwent breast reconstruction within four months of a mastectomy. Typically, immediate reconstruction is suggested, said Alderman, although there are exceptions.

Among the more than 51,000 women identified, 16.5 percent had reconstruction between the years 1998 and 2002. Annual rates did not change significantly over time, but the researchers did find wide variation by location.

For example, between 2000 and 2002, just 4.5 percent of breast-cancer patients in Alaska who underwent mastectomy opted for reconstruction, compared to nearly 35 percent of patients in the city of Atlanta. But that rate fell again in rural Georgia, where only 13.2 percent of patients opted for breast reconstruction, the researchers said.

While nearly one-quarter of patients in Detroit had reconstruction, just 14.4 percent of those in San Francisco did, and 13.4 percent of Los Angeles women.

Ethnicity plays a role, too, Alderman found. White women are most likely to get reconstruction, while minority women are less likely to do so.

"I think breast reconstruction is great, that is what I do for a living," said Alderman, a plastic surgeon. She acknowledged, however, that as women age, they tend not to think it is as important as do younger women.

Even so, she said, all women who have a mastectomy should be offered the option of reconstruction surgery. "My concern is there are some women out there who are not hearing about it."

"The law was passed thinking the rate was too low," Alderman said. "Either this [study] means the law wasn't needed, or the law didn't address the problems that exist."

The study results raise more questions, Alderman said. Her team will next look at the database to determine who got immediate reconstruction, who delayed it, who declined it, and why.

"We want to look to see what factors influenced the decision-making process," she said. That might include patients' socioeconomic status, the feelings of their partner and other family members about reconstruction, and how much information they get from their doctor.

Alderman suspects that some minority women may decline the operation due to general wariness about the health-care system.

Dr. Albert Losken, an associate professor of plastic surgery at Emory University School of Medicine in Atlanta, said the number of women getting reconstruction in the study "seems low." But he, like Alderman, is not sure why. Since the researchers assessed who got reconstruction within four months, perhaps some women did get the operation but delayed it beyond the four months, he said.

In some cases, he speculated, a woman may not be offered the option. In that case, he advised them to ask around and find out which doctors in the vicinity do offer reconstruction.

More information

To learn more about breast cancer and reconstruction, visit the American Cancer Society.

SOURCES: Amy Alderman, M.D., Ph.D., assistant professor, surgery, Ann Arbor VA Medical Center and University of Michigan, Ann Arbor; Albert Losken, M.D., associate professor, plastic surgery, Emory University School of Medicine, Atlanta; Jan. 25, 2006, Journal of the American Medical Association
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