WESTPORT, CT (Reuters Health) Feb 06 - In a convenience sample of US women who underwent mastectomy in 1994 or 1995, only 8.3% had breast reconstruction at the time of mastectomy or within 3 months, researchers report in the January issue of the Journal of the American College of Surgeons.

Dr. Monica Morrow, of Northwestern University Medical School, in Chicago, and colleagues analyzed National Cancer Data Base figures on the use of breast reconstruction in 155,463 women who underwent mastectomy between 1985 and 1990. They compared patient and tumor factors that influenced the use of breast reconstruction in this cohort with those of 68,348 women who had mastectomy between 1994 and 1995. "The single most important factor predicting the use of reconstruction was patient age," the authors write. From 1994 to 1995, patients aged 50 years and younger were 4.3 times more likely than their older counterparts to undergo reconstruction.

Multivariate analysis of the data indicated that patients treated at National Cancer Institute-designated cancer centers, compared with all other types of hospitals, were 40% more likely to undergo reconstruction. Patients in the highest income bracket were twice as likely to have reconstruction, while those living in the south and midwest US were 30% less likely to undergo breast reconstruction than patients living in other US regions.

The researchers also found that patients with ductal carcinoma in situ were twice as likely to have reconstruction as patients with invasive cancer. Dr. Morrow told Reuters Health that "surgeons may be concerned that reconstruction impairs the ability to identify recurrent cancer at the surgical site [but] multiple studies do not support this concept." "Breast reconstruction is an underused option in breast cancer management," the authors conclude. "Predictors of the use of reconstruction do not reflect contraindications to the procedure, and indicate the need for both physician and patient education." J Am Coll Surg 2001;192:1-8.