Physician’s Corner—

October Is National Breast Cancer Awareness Month

By Joseph O’Connell, MD

As a board-certified plastic surgeon practicing in Westport who regularly works with breast cancer survivors and those at risk for the disease, I strongly urge support of October as National Breast Cancer Awareness Month by reminding the women you love to schedule regular cancer screenings.

Early detection through self-examination, mammography, and medical screening are key prevention methods. It is estimated that 211,240 new cases of invasive breast cancer will occur this year in American women and more than 40,410 will result in death. The American Cancer Society estimates the lifetime risk of developing breast cancer at one in eight and the chance of dying from the disease at about 1 in 33. There is, however, reason to be optimistic as cure rates for those with early-stage ductal carcinoma have increased to 99 percent with early diagnosis and prompt treatment. Death rates from breast cancer have decreased every year since 1991 and we are better able to identify those at higher risk by examining hereditary, historical, and familial factors as well as testing for the BRCA-1 and BRCA-2 genes.

Currently the American Cancer Society recommends that women age 40 and older should have a yearly screening mammogram and clinical breast exam. Women in their 20s and 30s should have a clinical breast examination as part of a periodic (regular) health exam by a health professional. Women at increased risk should speak with their physician about starting mammograms at a younger age and about having additional tests or more frequent exams. The American Cancer Society believes that a combined approach with mammography, clinical breast examination (including self-exam), and finding and reporting any breast changes early offers women the best opportunity for reducing the death rate through early detection.

Advances in plastic surgery and breakthrough legislation have made the devastating news easier to bear. Improvements in postsurgical therapies, including breast reconstruction options, are helping allay the fear of disfigurement from mastectomy. Typically, plastic surgeons make recommendations based upon patients’ age, health, anatomy, tissues, and goals. The most common procedures include skin expansion followed by use of implants, or flap reconstruction. Breast conservation surgery, newer procedures such as skin-sparing mastectomies, improved implant designs and adjuvant therapy have all helped advance breast cancer treatment and have improved aesthetic results. In the past five years new designs in tissue expansion have streamlined the reconstructive process, decreased pain, and increased safety with more consistent and pleasing results.

In the very near future we anticipate FDA approval of a new generation of gel implants that will greatly expand a woman’s choice in reconstruction. Ongoing research with adult stem cells offers hope for improved contour and decreased scarring with an improved aesthetic result.

Equally important to breast cancer survivors is the 1998 passage of the Women’s Health and Cancer Rights Act (WHCRA) that mandates insurance coverage for breast reconstruction following a mastectomy. Board-certified plastic surgeons, such as myself, know firsthand how breast reconstruction improves a survivor’s self-esteem and confidence after a mastectomy.

The American Society of Plastic Surgeons (ASPS) was major supporter of the WHCRA, and is proud to have been part of the effort to stop insurance denials for the surgery. Now almost every woman who loses her breast to cancer can have it rebuilt through reconstructive surgery and discussion about this can start immediately after diagnosis. While breast reconstruction following mastectomy increased 131 percent between 1992 and 2003, it has decreased 22 percent over the past four and 8 percent in the past year with 62,930 procedures performed in 2004. The economic realities of decreased and delayed reimbursement and soaring professional liability insurance rates for surgeons are the likely explanations for this alarming trend. Recent work has affirmed that implant-based breast reconstruction does not increase the risk of cancer recurrence or spread and does not impede clinical or radiologic detection of recurrence.

Increasing numbers of women are taking proactive steps toward cancer prevention with a trend toward a greater percentage of prophylactic mastectomies compared with mastectomy for established breast cancer. Recently, a study published in the journal Plastic and Reconstructive Surgery that reviewed data on 32,000 women found that patients who are at high risk for breast cancer may lower their risk by 50 to 70 percent from breast reduction surgery. Most women know that breast reduction can provide a near miraculous improvement in back, shoulder, neck and breast pain, skin rash, and other symptoms while maintaining sensation and ability to breast-feed in the majority of cases. Breast reduction has always been a special interest of mine and today, many of the breast reductions I perform at Bridgeport Hospital are scheduled as ambulatory procedures with the woman able to return to her home and the care of her loved ones that very same day.

While the concept of breast reduction for cancer risk reduction is new, its superior aesthetic outcome may provide reassurance for high-risk women and ease the physical and psychological trauma for those facing bilateral prophylactic mastectomy. Last year 105,592 women underwent breast reduction and it is anticipated that this number will increase by considering this option for those at high risk for breast cancer.

ASPS members are well aware of the devastating effects of breast cancer and we support all women in their fight against the disease. For all breast cancer patients and now for those at high risk for the disease, the following is suggested: talk to a board-certified plastic surgeon regarding reconstructive and preventative options and discuss the pros, cons, and realistic expectations of those choices. To assist women with this decisionmaking process, visit the websites of the American Society of Plastic Surgeons, www.plasticsurgery.org; the FDA, www.fda,gov; the American Cancer Society, www.cancer.org; Plastic Surgery of Southern Connecticut, www.plasticsurgeryct.com and www.breastimplantsafety.org.

For additional information contact my office at 203-454-0044 or the American Society of Plastic Surgeons at 1-888-4PLASTIC.