Monday, April 21, 2008

More on decision making in breast cancer treatment...

It has been a few weeks since my last post. It is amazing how life sometimes gets in the way of sitting down and thoughtfully posting a blog entry. I am excited about some recent things that have happened and I hope they allow me to continue to improve on how I and others provide care for women with breast cancer.

A few weeks ago, I was invited to Ethicon Inc., a subsidiary of Johnson & Johnson, to give an educational lecture about breast cancer reconstruction. Ethicon is a medical device company with a plastic surgery product division. Most of their products are sutures and equipment related to wound closure, especially in the bariatric and post-bariatric body contouring market, but they are marketing a product that they hope will be useful in reconstructive plastic surgery. I hope to talk more about the product in the future, but briefly, it is an allograft - human tissue harvested from cadavers and processed so that when implanted in a patient it is not recognized as foreign tissue and rejected. It serves as a scaffold for wound healing and regeneration, and has an expanding role in certain techniques in breast reconstruction. It is marketed under the name Flex-HD. I am hoping to work with Ethicon in developing educational tools for patients and clinicians dealing with issues in reconstructive breast surgery.

I was also recently appointed as Chief of the Division of Plastic Surgery at Good Samaritan Hospital in West Islip, NY. I am looking forward to interfacing with the Breast Health Center at Good Samaritan and working to create a local and regional Specialty Center for Breast Restoration for immediate breast reconstruction after mastectomy and for the prevention and treatment of deformities associated with breast conservation surgery. As a surgical attending on the staff at Good Samaritan for the last several years, I have been privileged to develop a busy clinical practice in breast reconstruction. I would like to work with others at the hospital formalize the working relationships among all the specialties caring for women with breast cancer - those involved with diagnosis, support, and treatment.

Anyway, in my last post, I was discussing some issues regarding decision making in surgical treatment. There are some interesting research reports that shed some light on this process as it pertains to making decisions for surgical treatment of breast cancer. Does what the breast surgeon discuss at the initial consultation affect women's choices for treatment? Are their decision aids that can be used to improve communication and enable women to make choices more effectively? Should the decisions for initial surgical treatment be made by the physician, the patient, or shared? The list of questions seems almost endless! Imagine the challenges that women who are recently diagnosed with breast cancer face when they need to make surgical choices to begin their treatment.

Amy Alderman, MD and her colleagues continue to do pertinent research in this area. They surveyed patients and surgeons (in a defined group of breast cancer patients in Detroit and Los Angeles) asking whether patients reported having a discussion regarding breast reconstruction with the breast or general surgeon, whether the discussion had an impact on their willingness to be treated with mastectomy, and whether the patients, in fact, had received mastectomy as primary treatment of their breast cancer. This study is reported in the journal
Cancer in 2008. What Alderman and her colleagues found was quite informative. In their study, only 33% of surgeons discussed breast reconstruction during the decision making process. The discussions were more often with younger women who were more educated, and who had larger tumors. Knowing about the reconstructive options significantly affected patients willingness to undergo a mastectomy. In fact, patients who discussed reconstruction at the initial consult were 4 times more likely to undergo mastectomy than those who did not.

I will discuss decision aids and the idea of "shared" decision making in the next post. I am finding that each blog entry can branch off in so many different directions. I am looking forward to read the comments to see if readers have questions in a particular area.


Just One of Many said...

It is good news that you will work to enhance the Breast Health Center at Good Samaritan. Until God and Mother Nature decide that we no longer need breasts (perish the thought!), we will need competent and compassionate professionals like you in the field of breast health.

I find the whole idea of the allograft fascinating. The concept of donating any and all usable "parts" after passing has always appealed to me.

As for making surgical decisions, I am all for the shared approach. I absolutely wanted a doctor to tell me what to do, which wasn't happening. I gathered information and did a lot of reading and research, but it was ultimately a simple T-chart of pros and cons and making a list of my priorites that helped me decide.

tom said...

I had a massectomy a year ago with admediate reconstruction on one breast. In two weeks the doctor will go back in and use the FlexHD to give the implant more support for it has fallen at least an inch below my natural breast, I had DCIS type breast cancer. Pathology showes it in every section so the massectomy was a good decision. The Mammagram only showed it one small area. I was concerned about the doctor using FlexHD but not now. Thank You. KZ of los angeles

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