The 2008/2009 National Mastectomy and Reconstruction Audit have revealed some disappointing but not surprising figures. Of the circa 48000 new breast cancer diagnosis, one third of the women required a mastectomy instead of a 'lumpectomy'. This is the expected proportion.
However, of this approx. 16000 patients who had a mastectomy, only one fifth had an immediate reconstruction ( approx. 3000). Which means that four fifths of patients ( approx. 13000 ) undergoing mastectomy were not offered or were not advised to have an immediate reconstruction.
This contravenes the NICE (National Institute for Health and Clinical Excellence) guidelines set out in 2002 and 2009 which states that all women undergoing mastectomy should have access to reconstruction.
The figures for immediate reconstruction in the Midlands is lower than the national average and there are a few reasons I can personally think of.
Some of the Trusts are now offering complex reconstructions which gives a better cosmetic and functional result. However, they have failed to provide the infrastructure and manpower to support this more lengthy procedure and ironically now have to restrict the numbers done in order to meet datelines for the cancer management.
Bureaucrats and politics have stopped the mutually beneficial partnership between the NHS and the private sector where the private sector could help with the overflow of patients at NHS tariffs.
Details of theaudit can be found in the article in The Independant newspaper.
Breast reconstruction is an integral part of the management of women who are unfortunate enough to be diagnosed with this most common of female cancers. The psychological and physical benefits are well documented and very emotive ( testimonials ). I think it is time that the people who make decisions regarding it's availability start to make some sensible decisions.
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