Education is key
Though most women with breast cancer are aware they have the option for breast reconstruction soon after surgery, few may fully understand the details of the procedure, a new study suggests.
This was particularly the case, researchers found, for black women, who were more likely to say they did not know enough about breast reconstruction or to feel that the procedure was not recommended.In addition, only a minority of women — 38 percent — had breast reconstruction immediately or soon after undergoing a mastectomy, according to findings published in the journal Cancer.
This is in line with past studies finding that, although many breast cancer patients can have breast reconstruction at the same time as their mastectomy or soon after, relatively few women make that choice.
Most often, women in the current study said they opted not to have reconstruction because they wanted to avoid more surgery.
But there were also signs that many of the 646 patients were not fully informed about the procedure, according to the study team, led by Monica Morrow, M.D., of Fox Chase Cancer Center, Philadelphia.
For example, three-quarters of the women incorrectly believed that breast reconstruction makes it hard to detect cancer recurrences. This is a "critical factor" in the decision to undergo reconstruction, the authors note.
Movie and a makeover
U.S. doctors and ethicists have mixed feelings after learning that the woman who underwent the world's first partial face transplant had signed a film deal in which she would profit substantially from the movie's earnings.
The London Times reported that the patient, Isabelle Dinoire, British documentarian Michael Hughes and Dinoire's physicians signed the deal three months before the operation took place.
On one hand, doctors noted that the deal could have unduly influenced the 38-year-old Dinoire to agree to the surgery, and that it could motivate other physicians to prematurely attempt experimental procedures. But another doctor said that the film deal provided an income for a woman who would be unlikely to return to work any time soon.
"It is a real travesty," Raffi Der Sarkissian, M.D., a plastic surgeon and assistant clinical professor, Boston University School of Medicine, says in an e-mail. "I would not condone sale of photos, videos or details of the technique... . With the advent of 'reality shows' and exposure of techniques all over the media, there exists a risk of experimental procedures being done not for the advancement of surgery, but for money and self-aggrandizement."
Biomedical ethicist Jonathan Moreno, Ph.D., says he hopes that the French medical team explored the emotional impact the decision could have with Dinoire, who was severely disfigured after her dog mauled her face. The dog was trying to wake the woman up after she had taken sleeping pills in a suicide attempt, various news reports state.
"Physicians are supposed to protect their patients who must be emotionally vulnerable in this situation," Dr. Moreno, a professor of biomedical ethics at the University of Virginia, says. "Her psychological counseling should have included assessing the implications of this offer."
Dinoire was likely acting in her own best interest when she signed the deal, bioethicist Rosamond Rhodes, Ph.D., a professor of medical education, Mount Sinai Medical School, New York City, says.
"Even if her medical expenses are fully covered by the French national health system, it is hard to see how she would have had an income since she was mauled, how she can work during her recovery, or how she will find employment in the future," Dr. Rhodes says.