Immediate postmastectomy reconstruction tied to better breast cancer survival

NEW YORK (Reuters Health) - Immediate reconstruction following mastectomy is associated with a 26% reduction in breast cancer-specific mortality, according to a report in the October 15th issue of Cancer.

"Although the results of our study are interesting, it must be remembered that an association between postmastectomy reconstruction and improved survival doesn't mean causation," Dr. Michael Bezuhly from Dalhousie University, Halifax, Canada told Reuters Health. "I believe the difference in breast cancer-specific survival that we observed between women who did and did not undergo reconstruction is driven more by differences in access to care and socioeconomic status than any other factors."

Dr. Bezuhly and colleagues analyzed data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program to compare survival between patients who underwent mastectomy alone or combined with immediate reconstruction. The analysis included 54,660 women with a median follow-up period of 59 months.

As noted, women who had any type of immediate breast reconstruction, including implant and autologous reconstruction, had a 26% decrease in breast cancer-specific mortality compared with women who underwent mastectomy alone, the authors report.

The improved survival was present among women in all age groups, with those 70 years of age and older having the lowest risk of death among all those undergoing reconstruction.

In the subgroup of women undergoing implant reconstruction, only those younger than 50 years experienced a reduction in cause-specific mortality. Autologous reconstruction was associated with a survival advantage among women under 70 years.

"It is unclear why the results differ between autologous and implant reconstruction patients," Dr. Bezuhly said. "Some groups have suggested that the implant, being a foreign body, actually elicits a host response which may indirectly increase tumor immunosurveillance. More likely, the results are being driven by an unmeasured difference between these patient groups, be it in terms of general fitness and lifestyle choices, or access to health care."

Other factors associated with a lower breast cancer-specific mortality included younger age, being married, non-African American race, noninflammatory histology, estrogen receptor or progesterone receptor positive status, and absence of radiotherapy.

"Currently our group is undertaking a similar study using Canadian data," Dr. Bezuhly said. "The advantage of a Canadian study is that access to care in the Canadian universal health care system is, in theory, less of an issue. In addition, the Canadian data provides us with many variables that we were unable to capture through the US SEER registry, namely comorbidities and socioeconomic factors like education and income level."

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