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Study finds mountain women less likely to get this surgery



A new study by the University of Kentucky’s Markey Cancer Center shows Appalachian women are less likely to receive breast reconstruction after a mastectomy.

Chase Burns, plastic surgery resident (PGY 6 – Chief year) at UK, explained the study was prompted by the doctors noticing a trend with their patients.

“Anecdotally we saw women coming from the eastern part of the state were fewer than the women in the Lexington and surrounding area,” Burns said. He noted that the health disparity between Appalachian and non Appalachian regions had been explored in other areas but the realm of plastic surgery had not yet been taken into consideration.

Dr. Ryan DeCoster, a postdoctoral research fellow with the UK Division of Plastic and Reconstructive Surgery and Markey Cancer Center, explained that their study focused on information from The Kentucky

Cancer Registration about women who have had breast cancer as well as women that had undergone breast reconstruction. DeCoster said what they found was women from the Appalachia region were about 46% less likely to receive reconstruction. DeCoster noted that the Appalachian women also tended to present with later stages of cancer.

“When they are later in the disease process, it has already spread through the body and it is less likely that women will undergo reconstruction or they are limited in their choice to undergo reconstruction because chemo and radiology may complicate the process,” Burns said.

A press release about the study states that studies have shown that reconstruction improves quality of life, self-esteem and sexuality.

DeCoster explained they had “a couple of thoughts” of why Appalachian women were less likely to receive reconstructive surgery.

“One reason is access to a reconstructive plastic surgeon,” DeCoster noted.

He explained studies have shown that if someone is more than 20 miles from a plastic surgeon they are less likely to get work done with one. In the current study, DeCoster said they used one plastic surgeon from the Appalachian region and 20 from the rest of the state.

Another important concept, according to DeCoster, is the general surgery referral pattern.

“The big thing is a lack of patient education,” he said. “At the initial breast cancer diagnosis when the patient is meeting with the breast surgeon, they must educate the patient on the idea of reconstruction as well as setting up a referral. So if that conversation never happens theoretically the patient doesn’t know the reconstruction process.”

Moving forward, DeCoster says that they want look at referral patterns and if education is being given. They also plan to look at the factors involved in those educated about reconstructive surgery deciding whether or not to get the surgery.

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