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Breast reconstruction varies by race

Less-acculturated Latinas least likely to have reconstruction after breast cancer surgery

Latinas who spoke little English were less likely to undergo reconstruction surgery after a mastectomy for breast cancer, according to a study from researchers at the University of Michigan Comprehensive Cancer Center.

The study compared breast reconstruction among white women, African-American women, Latina women who were highly acculturated and Latina women who were less acculturated. Acculturation is a measure of how much a person is integrated into American society. For Latinas, a significant factor is whether they speak primarily English or Spanish.

The researchers looked at 806 women treated for breast cancer in Detroit and Los Angeles. They found 41 percent of white women and 41 percent of highly acculturated Latinas underwent reconstruction, while only 34 percent of African-Americans and 14 percent of less acculturated Latinas did.

Results of the study appear online Oct. 5 in the Journal of Clinical Oncology.

"We have good data that shows reconstruction after mastectomy improves quality of life. This is a body part that affects women's self esteem, body image, sexuality and social roles. Not all women should necessarily choose reconstruction – it's not right for everyone. But all women should be presented the option," says lead study author Amy Alderman, M.D., M.P.H., assistant professor of plastic surgery at the U-M Medical School.

The study authors found that the lagging reconstruction rates did not correlate to a lack of interest. In fact, more than half of the less-acculturated Latinas said they would have liked more information about breast reconstruction. This group was also less likely to report that their surgeon explained breast reconstruction, and they were less likely to be referred to a plastic surgeon than the other racial groups.

"Reconstruction is important to these women, but significantly more of the less-acculturated Latinas did not know how to get it. It suggests significant unmet needs for this vulnerable group. They have a desire for reconstruction, but no one's telling them about it," Alderman says.

The study showed similar trends for African-American women, although the most striking data was among the less-acculturated Latinas.

Breast reconstruction was tied to patients' satisfaction with their surgery. The highest satisfaction rates were from white women who had received reconstruction, among whom 94 percent were satisfied with their treatment. The lowest satisfaction, 56 percent, was among less-acculturated Latinas who did not receive reconstruction.

The study authors suggest more efforts must be made to present breast reconstruction options to all patients, including those who speak only Spanish. Further research is planned to understand how language and other cultural issues affect whether women receive breast reconstruction.

Breast cancer statistics: 194,280 Americans will be diagnosed with breast cancer this year and 40,610 will die from the disease, according to the American Cancer Society

Additional authors: Sarah Hawley, Ph.D., U-M Medical School and VA Ann Arbor Healthcare System; Nancy Janz, Ph.D., U-M School of Public Health; Mahasin S. Mujahid, Ph.D., Harvard School of Public Health; Monica Morrow, M.D., Memorial Sloan-Kettering Cancer Center; Ann S. Hamilton, Ph.D., University of Southern California; John Graff, Ph.D., Karmanos Cancer Institute; and Steven Katz, M.D., M.P.H., U-M Medical School and VA Ann Arbor Healthcare System

Funding: Robert Wood Johnson Foundation, National Cancer Institute

Reference: Journal of Clinical Oncology, DOI: 10.1200/JCO.2009.22.2455

U-M Cancer AnswerLine, 800-865-1125
U-M Comprehensive Cancer Center,

Nicole Fawcett | EurekAlert!
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