A low rate of breast reconstruction among women who have had a mastectomy may be due to a lack of knowledge about the procedure by referring physicians, says a University of Toronto study.

Breast reconstruction can have a positive impact on a woman's quality of life after a mastectomy, but the overall rate of reconstruction in Canada is low at 7.9 percent. The study in the journal Plastic and Reconstructive Surgery found that referring physicians (family physicians, general surgeons or oncologists) rated their level of knowledge of reconstructive breast surgery as low; plastic surgeons rated the referring physicians' knowledge as even lower.

For example, despite evidence to the contrary, more than one-third of referring physicians believe breast reconstruction delays the detection of cancer recurrence and adversely interferes with cancer therapy. The study's findings were based on focus groups, surveys and interviews of Ontario primary care physicians, general surgeons, oncologists and plastic surgeons.

The research team also found that patients older than 49 were not being referred for breast reconstruction despite the fact that plastic surgeons would consider them to be potential candidates. Female physicians and surgeons were more likely than their male counterparts to refer patients who were age 60 or older.

"These deficiencies in information, knowledge and learning needs should be addressed by educational interventions during residency training and through continuing education for practicing physicians," says U of T surgery professor Dr. Mitchell Brown. Brown, a plastic, reconstructive and cosmetic surgeon at Sunnybrook and Women's College Health Sciences Centre (SWCHSC), was a co-author on the study led by Dr. Kyle Wanzel, a resident in the plastic surgery division of U of T's Department of Surgery.

SOURCES:
Plastic and Reconstructive Surgery, November 2002
University of Toronto (http://www.utoronto.ca)