Why are so few breast cancer patients in Ontario getting reconstruction surgery? U of T PhD student wants to find out

Hélène Retrouvey, a PhD student at the University of Toronto, is leading a qualitative study to explore the reasons behind Ontario's low rate of breast reconstruction surgery – with only 7.6 per cent of patients undergoing the procedure between 2004 and 2010.

“We really wanted to understand how and why breast cancer patients were experiencing barriers to access breast reconstruction,” said Retrouvey, who is also a plastic surgery resident.

“Within the principles of universal health care, all eligible patients should have access to this procedure, but looking at the data we can see that that not all patients have equal access.”

Breast cancer affects one in nine Canadian women, and mastectomies – the surgical removal of one or both breasts – can be part of treatment. The removal of the breast tissues can impact women’s self-esteem, sexual health and overall quality of life. Breast reconstruction surgery is an option available to breast cancer patients to restore the breast mound and form, and can provide long-term quality of life improvement and psychological benefits.

Yet in spite of these benefits, rates of breast reconstruction remain low. Patient factors like increased age, race, larger tumours or advanced stages of cancer, as well as negative physician perceptions, have all been shown to contribute to lower breast reconstruction rates.

“There is still a bit of stigma around the procedure because the breast is not always something that is considered required, like a limb,” said Retrouvey (pictured right), “and there are a lot of women who feel this procedure is not an option for them.”

Retrouvey’s previous study also identified additional perceived barriers like rural geographic locations, poor referral patterns by clinicians and the unavailability of plastic surgeons. But to date there have been no Canadian studies explaining how these barriers limit access to breast reconstruction surgery or how access rates might be improved.

Supported by her recently awarded Vanier Canada Graduate Scholarship, Retrouvey and her team will conduct a series of  interviews with breast cancer patients across the province, as well as physicians who refer or provide breast reconstruction, and administrators who are involved in the provision of the surgical procedure.

“The patient interviews will explore their experience with diagnosis and treatment of their breast cancer while placing on emphasis on their views of breast reconstruction,” explained Retrouvey. "The physician interviews will explore current practices, and administrator interviews will examine the current institutional treatment regimens as well as the availability and structure of breast reconstruction programs.”

To gain a thorough understanding of how and why these barriers are impacting breast reconstruction rates, the study will include women from diverse social and cultural backgrounds, as well as physicians and institutions at hospitals in high volume areas such as Toronto and London, and low volume areas like Thunder Bay. With the additional knowledge gained from the study, Retrouvey and her team will actively look to design new interventions that target these perceived barriers and improve access for breast reconstruction surgery to ensure that it is timely and equitable for all women in Ontario.

“We understand that not all women want breast reconstruction, and for some the scars are an important symbol of their cancer journey,” said Retrouvey. “But women shouldn’t be left without breasts because they don’t know their options.”