Maine Cancer Consortium Treatment Work Group
Maine Cancer Registry
Initial evaluation of treatment data for 2004–2006 in the registry database revealed that 18% of women undergoing mastectomy had reconstruction. We hypothesized that this figure might be low because of initial coding errors or late reconstruction, so we asked a representative sample of reporting hospitals to review medical records for evidence of reconstruction.
This follow-back resulted in an increase in reconstruction to 24%. Because of the number of corrections, we asked all remaining hospitals except the very smallest to perform the same review. Again, updates were done and consolidated in the central registry database. The final reconstruction percentage, with follow-back on 92% of women, was 25%.
Maine is primarily rural with only four locations in which plastic surgeons practice. The county of residence showed the lowest percentage of reconstruction in rural counties. A higher percentage of reconstruction occurred in counties with plastic surgeons.
We also found the mean age for women undergoing mastectomy was 60 years. The mean age for women who had reconstruction was 50 years, and the mean age for women who did not have reconstruction was 63. This age difference explains some of the geographic disparity in that the most rural counties have an older population. We also are evaluating histology and stage as potential factors in reconstruction decision making.
These data are used by the American College of Surgeons surgical liaison and the Cancer Consortium to educate surgeons throughout the state on the value of pre-mastectomy referral and evaluation for reconstruction options. Challenges include availability of plastic surgeons, distances patients must travel for reconstruction, and physician concern about the loss of patients from community hospitals.
Educating women (in addition to surgeons) is important. Consortium Treatment Work Group goals include advancing breast cancer care statewide. We previously evaluated breast cancer staging and breast conservation.