Darlene Dobkowski, MA

Most patients — 73.7% — who underwent a mastectomy without breast reconstruction reported that they were satisfied with their surgical outcome, according to a study published in the 

“For patients, the findings may serve to reinforce their decision and may provide some degree of support knowing that there are others who are making the same choice that they are,” said Dr. Deanna J. Attai, associate clinical professor in the department of surgery at UCLA David Geffen School of Medicine, in an interview with 

. “The findings may also help patients better communicate with their surgeons regarding their surgical choice.”

Flatties Unite: The Choice to Forego Breast Reconstruction

Some studies have highlighted that women who did not undergo reconstruction with their mastectomy were less satisfied and had a poorer quality of life compared with those who underwent immediate reconstruction, although Attai and her team wanted to look into this more after seeing contrasting reactions online.

“I was seeing an increasing number of women in the online communities openly discussing their ‘going flat’ experience, as well as seeing more online support and advocacy organizations for these women,” said Attai. “There seemed to be a disconnect between what I was reading in the surgical literature and what I was seeing in the online communities. That’s what sparked my interest. I think the findings are important because if all surgeons are exposed to are studies showing lower satisfaction, they may be less likely to recommend going flat to their patients.”

In this study, researchers surveyed 931 women (mean age, 49 years) who had a unilateral (one breast) or bilateral mastectomy (both breasts) to either treat breast cancer or potentially reduce elevated breast cancer risk. All women who completed the online survey did not undergo breast mound reconstruction. In the survey, women used a five-point scale to rate their satisfaction of the surgical outcome and the support they received from their surgeon throughout the process.

The decision to proceed with a mastectomy alone was the first choice for 73.7% of women in the study.

“While our respondent population may not be representative of the ‘average’ patient, it’s still a large number of women who were happy with their results,” said Attai.

Although 65.2% of patients reported that they received adequate information about their surgical options before making their decision, 20.7% reported that their surgeon did not support or respect their decision to go flat.

“(‘Flat denial’) is a term I learned from the patients, and it includes not initially being offered the option to go flat, being discouraged (by their surgeon) from going flat, or the surgeon not performing the agreed-upon procedure — intentionally leaving excess skin and later stating it was done in case the patient changed her mind about reconstruction (and that the excess skin could be used for a subsequent procedure,” said Attai.

Make it A Double: My Decision to Go Flat After Breast Cancer

Women reported that the main reasons for undergoing only a mastectomy is to avoid the placement of a foreign object in their body and to recover quicker than if they also underwent reconstruction. The mean score for satisfaction after mastectomy in this study was 3.72 out of 5.

The strongest predictor of a satisfaction score lower than three was a low level of surgeon support on their decision to go flat. Dissatisfaction with surgical outcome was also seen in patients with a BMI of 30 kg/m2 or higher and in those who underwent a unilateral mastectomy. In contrast, patients were more likely to report greater satisfaction if they received adequate information on surgical options and had a surgeon with a practice focused on specialized breast surgery.

There are some limitations to this study, including the survey that was used to collect information. “Our study was unique in that we did not use a validated survey tool to measure satisfaction, and the reason was that our patient advocates who partners with us felt that the primary tool was biased towards reconstruction,” said Attai. “Of course, that is one of the limitations of our work, and future work should be done to develop and validate a survey tool for this patient population.”

For more news on cancer updates, research and education, don’t forget to 

Articles

Although most patients reported satisfaction after undergoing a mastectomy without breast reconstruction surgery, 20.7% of women felt that their surgeon was not supportive of their decision to do so.

Many Women Are Satisfied After 'Going Flat' Post-Mastectomy, Study Finds

Dr. Valena Wright has spent the last 25 years specializing in the treatment of gynecologic cancers. All that experience, however, did not prepare her for when her sister, Debbie, would be diagnosed with ovarian cancer.

“When you study and practice all of these years, and a member of your family is diagnosed with ovarian cancer — which is the most serious or difficult to treat — I got to see things from a different perspective,” Wright, who is the director of gynecologic oncology at Lahey Hospital & Medical Center in Burlington, Massachusetts, said in an interview with 

®. “And I learned so much from being with my sister during her battle with ovarian cancer. I was disappointed in some of the correspondence or interactions that she had with the medical system.”

That disappointment led Wright to share her sister’s story, along with other women, in a recently released book, “It’s Time You Knew.” The reason for writing the book, according to Wright, is to raise awareness and help others avoid ever having to deal with a cancer diagnosis.

For more news on cancer updates, research and education, don’t forget to

Podcasts

In this episode of the “CURE Talks Cancer” podcast, we spoke with a gynecologic cancer expert about how her sister’s journey with ovarian cancer provided her with a different perspective that would lead to raising awareness for others. 

Oncologist Turned Caregiver Offers Guidance About Women's Cancers

Two methods to evaluate the response to therapy may not be accurate assessments in women with ovarian cancer, fallopian tube cancer or primary peritoneal carcinoma who were treated with chemotherapy before surgery, according to a study published in 

“This large evaluation in a clearly defined patient population demonstrates the difficulties in using current well-defined unidimensional radiological and biochemical response surrogates to assess the therapeutic impact of neoadjuvant chemotherapy in advanced high-grade ovarian cancer,” the study authors wrote. “Both response criteria imperfectly predict the ability to achieve complete or optimal cytoreduction at interval surgery — a more robust surrogate for survival, or indeed progression-free survival.”

The two criteria assessed in this study were Response Evaluation Criteria in Solid Tumors (RECIST) and cancer antigen 125 (CA125). RECIST requires CT scans, X-rays or MRI scans to measure at least one tumor, whereas CA125 is a marker that can be measured in blood, with reductions in CA125 indicating treatment response.

To analyze these two criteria, researchers utilized them in 779 women with fallopian tube, ovary or primary peritoneum cancer who underwent chemotherapy with carboplatin-paclitaxel followed by delayed primary surgery. In particular, patients were randomly assigned the following chemotherapy regimens, with a maximum number of six chemotherapy cycles allowed.

Carboplatin (capped at 900 mg) and paclitaxel (175 mg/m2 by body surface area, capped at 350 mg) on the first day of every 21-day cycle (257 patients; median age, 65 years);

Carboplatin (capped at 900 mg) on the first day and paclitaxel (80 mg/m2 by body surface area, capped at 160 mg) on days one, eight and 15 of every 21-day cycle (263 women; median age, 62 years); or

Carboplatin (capped at 300 mg) and paclitaxel (80 mg/m2 by body surface area, capped at 160 mg) on days one, eight and 15 of every 21-day cycle (259 women; median age, 64 years).

One of the outcomes of interest in this study was progression-free survival, defined as the time between radiological tumor assessment performed during presurgical planning and either disease progression or death, whichever occurred first. Follow-up was performed for a median of 29.5 months.

Of the women in the study, 564 had available data to be assessed by RECIST criteria, whereas 727 had available data to assess CA125 criteria. Complete or partial response to therapy was observed in 62% of women according to RECIST criteria compared with 84% of women who had a CA125 response.

Patients with complete or partial response to therapy according to RECIST criteria had a median progression-free survival of 14.4 months compared with 13.3 months for those who had stable disease using the same criteria. Median progression-free survival for women with a CA125 response was 13.8 months versus 9.7 months for those without a response.

Complete cytoreduction, or the absence of any visible disease, was achieved by 56% of patients with a complete or partial response to therapy according to RECIST criteria compared with 42% of those with stable disease. This was also achieved by 50% of patients with a CA125 response versus 30% of those without a response.

“We recommend … that RECIST and CA125 assessments should not be considered as standalone measures to stratify patients who are likely to benefit from (delayed primary surgery), but instead used in conjunction with the patient’s clinical capacity (eg, performance status and comorbidities) to undergo cytoreductive surgery,” the study authors wrote.

Two evaluations for treatment responses in women with ovarian, fallopian tub or primary peritoneal carcinoma may need to take into consideration other factors such as other existing conditions.

Responses to Therapy for Ovarian and Other Women’s Cancers May Have to be Assessed Beyond Imaging and Blood Test Modalities

Bob Dole, former Kansas senator and Republican presidential nominee in 1996, will soon undergo treatment for stage 4 lung cancer, according to a statement posted on Twitter.

“Recently, I was diagnosed with stage 4 lung cancer,” he said in the statement. “My first treatment will begin on Monday. While I certainly have some hurdles ahead, I also know that I join millions of Americans who face significant health challenges of their own.”

Dole, 97, was a Kansas senator from 1969 to 1996, and was the GOP presidential nominee in 1996 with his vice-presidential nominee Jack Kemp. Dole also ran with GOP nominee Gerald Ford in the 1976 election. In addition, he was the Senate majority and minority leader during his time in politics.

Before entering the political realm, Dole served in the Army with distinction during World War II, when he was seriously injured in Italy. Once he left Senate in 1996, he became a product endorser and political celebrity.

Former President Bill Clinton awarded Dole with the Presidential Medal of freedom in 1997, and he also received the Congressional Gold Medal in 2018. These are the highest civilian awards in the U.S.

“We know that Senator Bob Dole will face this challenge as he has so many others, with his charismatic strength, optimism and clever wit,” according to a tweet from the Elizabeth Dole Foundation, which was started by Dole’s wife and focuses on military and veteran caregivers.

Former longtime Kansas senator Bob Dole announced that he will be undergoing treatment for lung cancer next week.

Darlene Dobkowski, MA | Contributors

Many Women Are Satisfied After 'Going Flat' Post-Mastectomy, Study Finds

Oncologist Turned Caregiver Offers Guidance About Women's Cancers

Responses to Therapy for Ovarian and Other Women’s Cancers May Have to be Assessed Beyond Imaging and Blood Test Modalities

Bob Dole Announces Lung Cancer Diagnosis

Latest News