Mastectomy Reconstruction Rates Vary

B O S T O N, Aug. 18 -- Women diagnosed with breast cancer decide whether or not to have reconstructive surgery after a mastectomy based on a variety factors, from surgical stamina to self-image, but where they live shouldn’t be one of them.

Yet that is exactly what may be happening, according to a Connecticut epidemiologist who looked at patterns of reconstructive surgery across the country and found disturbing regional variations.

Anthony Polednak, an epidemiologist with the Connecticut Department of Public Health, wanted to see how his state compared with other regions across the country.

He analyzed statistics from the nine cancer registries sponsored by the National Cancer Institute, which are located in Detroit, San Francisco, Seattle, Atlanta, and the states Utah, Hawaii, Iowa, New Mexico and Connecticut. Although these areas cover only 15 percent of the country, the registries are thought to be statistically representative of the entire United States.

Polednak’s research examined more than 50,000 women under age 70 who’d had mastectomies from 1988 to 1995, and looked at how likely they were to have undergone reconstructive surgery soon after their operations.

Rates Four Times Higher His results, published in this month’s issue of Plastic and Reconstructive Surgery, found that women in Atlanta and Seattle were as much as four times more likely to undergo reconstructive surgery than women in Utah and Hawaii.

Specifically, only 3.3 percent of Hawaiian women and 4.2 percent of Utah women received the surgery, compared to 16 percent of Atlanta women and 11.4 percent of Seattle women, he reports.

Similarly, around 9 percent of women in Detroit and San Francisco received reconstructive surgery, while only half as many residents of New Mexico and Iowa did.

“There’s a large, geographic variation for patients who had reconstruction,” Polednak says. “I don’t know what the explanation is — whether it’s the attitudes of surgeons or the receptivity of the women themselves. I was surprised the differences were as large as they are.”