title: Correlates of breast reconstruction: results from a population-based study.
abstract: BACKGROUND
  Immediate or early postmastectomy breast reconstruction is performed infrequently. To the authors' knowledge, little is known regarding surgeon or patient perspectives on reconstruction treatment decisions. The purpose of the current study was to identify patient attitudes and preferences associated with breast reconstruction, and whether these differed by race.
  
  
  METHODS
  A sample of women age < or = 79 years who were diagnosed with ductal carcinoma in situ and invasive breast carcinoma between December 2001 and January 2003 was identified from the Surveillance, Epidemiology, and End Results (SEER) registries of Detroit and Los Angeles. Eligible subjects completed a questionnaire at a mean of 7 months after diagnosis. The Wald chi-square test and logistic regression were used for data analysis.
  
  
  RESULTS
  Of the 1844 respondents, 646 underwent a mastectomy (35.0% of the total sample) and 245 of these patients received breast reconstruction (38.0%; of the mastectomy group). On multivariate analysis, younger patient age, higher educational levels, and earlier stage of disease were found to be significantly associated with breast reconstruction. Although 78.2% of women reported that breast reconstruction was discussed, only 11.2% correctly answered 3 basic knowledge questions regarding the procedure. The desire to avoid more surgery was the most common reason for not undergoing breast reconstruction.
  
  
  CONCLUSIONS
  The results of the current study found that the majority of women were aware of breast reconstruction but choose not to undergo the procedure. Lack of knowledge and a greater perception of barriers to the procedure were more common among African-American patients and women with a lower education level, suggesting a need for improved educational strategies.
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111-2497, USA. Monica.Morrow@fccc.edu
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.forename: Mahasin
authors.initials: M
authors.lastname: Mujahid
authors.forename: Paula M
authors.initials: PM
authors.lastname: Lantz
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.forename: Kendra
authors.initials: K
authors.lastname: Schwartz
authors.forename: Lihua
authors.initials: L
authors.lastname: Liu
authors.forename: Dennis
authors.initials: D
authors.lastname: Deapen
authors.forename: Barbara
authors.initials: B
authors.lastname: Salem
authors.forename: Indu
authors.initials: I
authors.lastname: Lakhani
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
mesh_terms: D000368:Aged; D001294:Attitude to Health; D044383:Black People; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005006:Ethnicity; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000523:psychology; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010353:Patient Education as Topic; D012042:Registries; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D001741:Black or African American