How are we plastic surgeons with screening prior to cosmetic breast surgery? This article from November 2009 (full reference below) reviews this topic. Note this survey was done prior to the release of the new USPSTF guideline recommendations for screening mammograms the same month. I wonder if a new survey would have different outcomes.
The article reports on a study which looked at breast cancer screening practices of American plastic surgeons (self-reported) and the degree to which those practices adhere to the American Cancer Society guidelines.
The study was conducted using an online survey of the members of the American Society of Plastic Surgeons over a 5 month period (January 2008 to May 2008). The 20 multiple-choice questions were designed to assess physician practice composition and familiarity with American Cancer Society guidelines, and to ascertain specific practices for preoperative evaluation and breast cancer screening in patients seeking aesthetic breast surgery. The survey comprised four components: general practice information, breast cancer screening practice, criteria for obtaining breast cancer screening, and criteria for further evaluation of breast cancer risk.
There were 1094 respondents (out of 4520 society members), so only a 24% response rate. Twenty-eight responses were excluded because these surgeons responded that they do not do breast surgery, do not operate, are pediatric surgeons, are retired, or work with cancer patients only on an initial screening question.
Of the 1066 included respondents, 82% were male and 73% were in private practice. The participants were roughly evenly distributed with respect to total years in practice, and a majority of surgeons performed augmentation mammoplasty, reduction mammoplasty, and mastopexy (96%).
In total, only 47% appeared to follow the American Cancer Society guidelines. Only 64% claimed familiarity.
Not all responders always reviewed risk factors preoperatively in their aesthetic breast surgery patients (only 89%), nor did all responders always perform a clinical breast examination preoperatively (86%).
- 89% of respondents claimed that they obtain mammographic screening based on age
- 57% claimed to do so based on positive family history, regardless of age
- 61% stated they followed the ACS screening guidelines, 61 percent stated that they did follow the guidelines
- 24% stated that they did not know the guidelines
Seventy-five percent (n = 799) of plastic surgeons considered a mammogram within 1 year to be valid, whereas 15% (n = 166) stated that this was age dependent.
The authors concluded:
Breast cancer is a major public health problem, for which screening is at least part of the solution. Plastic surgeons are in a unique position to screen women who may not otherwise receive screening. Knowledge of the American Cancer Society guidelines is an essential component of effective cancer screening, but unfortunately only somewhat more than half of plastic surgeon respondents who perform breast surgery have knowledge of these guidelines. Being male predicted more accurate knowledge of the guidelines, but being female resulted in more aggressive screening, and possibly more diagnoses. Familiarity with the American Cancer Society screening guidelines also resulted in a greater number of perioperative diagnoses. As plastic surgeons, we have an obligation to actively participate in the health and well-being of our patients, and this involves understanding and applying good breast cancer screening practices.
New Breast Cancer Screening Guidelines (November 17, 2009)
The New Mammogram Guidelines - What You Need to Know (December 27, 2009; TBTAM)
Screening Mammogram Recommendations (January 7, 2010)
USPSTF Breast Screening Guidelines Pushback (January 26, 2011)
Breast Cancer Screening Prior to Cosmetic Breast Surgery: ASPS Members' Adherence to American Cancer Society Guidelines; Selber, Jesse C.; Nelson, Jonas A.; Ashana, Adedayo O.; Bergey, Meredith R.; Bristol, Mirar N.; Sonnad, Seema S.; Serletti, Joseph M.; Wu, Liza C.; Plastic & Reconstructive Surgery. 124(5):1375-1385, November 2009; doi: 10.1097/PRS.0b013e3181b988c4