1. Mastectomy and Reconstruction In Asian Breast Cancer Patients
“Do disparities exist in surgical treatment and post-mastectomy reconstruction between Asian and Caucasian patients with breast cancer?”
Navneet Randhawa
Supervisor: Professor Anil Jain
Statistics: Sigrid Whiteside
University Hospital of South Manchester

2. Outline Surgical treatment of breast cancer
Post-mastectomy reconstruction
Key findings from mastectomy and reconstruction study
Relevance for Asian women

3. 50 000 new breast cancer cases diagnosed per year in UK
Surgical Treatment
new breast cancer cases diagnosed per year in UK
Surgical Treatment
Mastectomy
Breast Conserving Surgery
80%
40%
60%

4. Mastectomy Reconstruction
Surgical Treatment
Mastectomy
Reconstruction

5. Breast Reconstruction
BENEFITS
SAFE OPTION IN MOST PATIENTS
IMPROVED OVERALL SATISFACTION
IMPROVED BODY IMAGE
IMPROVED SELF-ESTEEM
FEELING OF ATTRACTIVENESS
DECREASED ANXIETY AND DEPRESSION
IMPROVED QUALITY OF LIFE

6. Breast Reconstruction
Immediate
Delayed
20%
NICE guidelines recommend that all patients who undergo mastectomy should be offered breast reconstruction, unless there are significant contraindications.

7. Objectives
To investigate differences in surgical treatment and post-mastectomy reconstruction between Asian and Caucasian breast cancer patients.

8. Methods Mastectomy rates for non-invasive and invasive carcinoma
Patient Selection:
Jan 2009 – May 2014
Surgical treatment
Primary breast cancer
161 Asian
161 Caucasian
Mastectomy rates for non-invasive and invasive carcinoma
Immediate and delayed reconstruction offer rates
Immediate and delayed reconstruction uptake rates

9. Results: Key Findings
Mastectomy rates higher in Asian cohort for treatment of non-invasive cancer (DCIS). Mastectomy rates similar in Asian and Caucasian cohort for treatment of invasive cancer
No difference in immediate or delayed reconstruction offer rates between Asian and Caucasian cohort. No reason provided for not offering reconstruction in substantial proportion of cases.
Reconstruction uptake rates lower in Asian cohort

10. Results: Mastectomy Rates
Asians 67%
Caucasians 28%
Surgical Treatment for Non-Invasive Cancer

11. Results: Immediate Reconstruction Offer Rates
Asians 57%
Caucasians 67%
Immediate Reconstruction Offer Rates by Ethnicity

12. Results: Delayed Reconstruction Offer Rates
Asians 33%
Caucasians 39%
Delayed Reconstruction Offer Rates by Ethnicity

13. Results: Immediate Reconstruction Offer
Reasons for not offering immediate reconstruction

14. Results: Delayed Reconstruction Offer
Reasons for not offering delayed reconstruction
86%

15. Results: Immediate Reconstruction Uptake Rates
Asians 54%
Caucasians 67%
Immediate Reconstruction Uptake Rates by Ethnicity

16. Results: Delayed Reconstruction Uptake Rates
Asians 14%
Caucasians 79%
Delayed Reconstruction Uptake Rates by Ethnicity

17. Relevance for Asian Women
Incidence of breast cancer has increased in Asian women
Asian women tend to develop breast cancer at a younger age
Average age for Asian women in 45
Average age for Caucasian women is 57
Good survival rates after breast cancer
Reconstruction has several benefits and improves quality of life
Reconstruction is even more relevant in Asian women who develop breast cancer at a younger age, and so have longer survival

18. Conclusion In UK, reconstruction rate is about 20%
At UHSM, immediate reconstruction rate is 60%
First study to look at ethnic disparities in post-mastectomy reconstruction in UK
Future study to investigate why
Patients should be provided with understandable information about all suitable surgical treatment options available to them:
Breast conserving surgery versus mastectomy
Post-mastectomy reconstruction