Breast cancer is a devastating diagnosis for any woman. There’s so much for a patient to contend with—from learning about the disease and treatment options to dealing with the emotional impact and its effect on self and family. It’s not too surprising that making a decision about breast reconstruction tends to take a back seat.
The American College of Surgeons (ACS) wants to change that. The organization has developed a new computer-based learning module to help women consider breast reconstruction early in their breast cancer journey.
In a press release published during the organization’s October 2009 Clinical Congress, Dr. Bernard T. Lee of Beth Israel Deaconess Medical Center and Harvard Medical School described a recent study in which a group of women were given a computer-based decision-making CD. The CD presents breast reconstruction approaches and data on surgical outcomes. It discusses what the procedures and recovery are like and includes pictures and diagrams. According to Dr. Lee, it is both comprehensive and user-friendly.
The study showed that women who used the CD were more likely to feel a strong sense of involvement in the breast reconstruction decision than those who did not see the module. Those who used the program retained more information about reconstruction and many more reported being satisfied with their learning experience than those who did not use the CD.
Dr. Lee noted that the CD can be given to a patient to take home and study at her leisure. It can also be shown to patients before a traditional office consultation. Either way, Dr. Lee hopes that a tool like this will help patients understand their choices thoroughly and make an active, informed decision about what’s best for them.
The ACS hopes that when women are well informed, many will choose reconstruction. Obviously ACS members are generally pro-surgery, but the group also points to the many studies over the last two decades that have shown dramatic improvements in self-esteem and body image for breast cancer patients who have undergone reconstructive surgery. One notable study of 250 women at the University of Michigan showed they made statistically significant gains in mental health, emotional well being, energy level, performance of daily activities and satisfaction with the look of their breasts.
Another study also released at the recent ACS Clinical Conference chronicled the breast reconstruction decisions of patients who were referred to a plastic surgeon for consultation vs. those who were not. Not surprisingly, a huge percentage of patients who received a plastic surgery consultation chose to undergo reconstruction. None of those who did not see a plastic surgeon elected reconstruction.
The ACS sees these two studies as having a message for both surgeons and patients. Breast surgeons who perform mastectomy surgery need to realize that they are the “gatekeeper” for breast reconstruction as well. They need to provide information and referrals to plastic surgeons. The ACS says that the message for patients is to take control of their decision-making and ask for these services.
The cynical among us can make the point that surgeons want to perform surgery; therefore it’s in their best interests to “sell” women on breast reconstruction. But keeping in mind the self-esteem effects of reconstruction, also consider this: the ACS says that today only 20% of the women who are eligible for reconstruction elect to have the surgery. With 89% of women with breast cancer now surviving five years after diagnosis and 75% after 15 years (American Cancer Society figures for 2009) clearly there are more women out there who could benefit from reconstruction.
If you or someone you love is facing mastectomy, you owe it to yourself get all the information you can.