Abstract P6-11-15: Information gaps and perceived barriers to achieve breast reconstruction among patients with mastectomy in a public breast cancer center in Mexico
Authors: Bajonero-Canonico Paulina , Miaja-Avila Melina , de la Rubia José Moral , Saldaña-Rodríguez Jorge A , Hinojosa-González David E , De la O-Maldonado Cristel G , Villarreal-Garza Cynthia M 
Published: March 2020

Abstract
Introduction: Multiple studies have reported that breast reconstruction (BR) after mastectomy is paramount in the global treatment of breast cancer (BC). Despite this, BR rates in Mexico are very low (7-16%), which may be explained by the fact that BR is not completely covered by public institutions in our country. Even though BR rates can increase when pertinent information is offered to patients, little is known about the level of information among Mexican patients. We sought to assess the level of information that patients who underwent mastectomy had about BR in a Mexican referral BC center with public healthcare insurance where BR services are not covered, as well as its relationship with their decision-making and the main reasons why they would or would not want to have BR.
Methods: A written questionnaire was applied to 110 women who underwent mastectomy to assess their knowledge and desire for BR, and the reasons for or against it. We then analyzed the differences in information perception between women who did or did not desire BR.
Results: Mean age was 51 years (30-78). Most patients had lower education (61%), 29% had a monthly income &lt;300 USD, 73% were responsible for their household income, and 57% had ≥3 children. Most patients had tumors &gt;5 cm (66%), with a high proportion of locally advanced clinical stages (67%). Mean times since diagnosis and since mastectomy were 2.2 and 1.9 years, respectively. Two-thirds of patients wished to have BR. Only 28% looked for information about BR; 65% did not recall ever receiving any information about BR from their doctors; 76% said they were not advised by their providers to undergo BR; 83% never asked their doctors for information regarding BR; and 84% believed they did not have enough information about BR. Notably, 12% of patients received their families’ advice not to have a BR.
Seven domains were significantly associated with the desire of having a BR. More patients who did not desire a BR than those who did, reported they did not receive or look for information, advice or counseling about their BR options (see table).
The five main reasons to have BR were: 1) It would give me freedom to dress in any kind of clothes; 2) To make my breasts look symmetrical; 3) To look like I used to before the mastectomy); 4) To feel more confident; and 5) To feel more attractive. The five main reasons not to have BR were: 1) I am worried about its cost; 2) I do not know the BR options; 3) I do not have enough information about BR; 4) I am worried the cancer could return; and 5) I am afraid that BR complications can happen.
Conclusion: This is the first study to evaluate the association between the information, advise and counseling patients receive about BR and their desire to undergo the procedure in an underserved setting such as the Mexican public healthcare system. The amount of information and counseling about BR significantly correlates with women's interest in this procedure. This lack of information about BR from providers might be mainly due to the lack of BR coverage in public services, which likely play a strong role on the low rates of BR in this country. For this reason, it is of utmost importance to ensure that a specific governmental or civil budget is directed to cover this procedure and, ultimately promote the delivery of BR-related information to all BC patients in a standardized manner.
Table. Differences in BR interest according to BR knowledgeQuestionsWould you like to have a breast reconstruction? n(%)No (n=37)Yes (n=73)Total (n=110)PNone of my doctors informed me about breast reconstruction30 (81)41 (56)71 (65)0.01None of my doctors advised me to have a breast reconstruction33 (89)51 (70)84 (76)0.024I never asked my doctor for information about breast reconstruction36 (97)55 (70)91 (83)0.004My doctor did not explain there are many types of reconstruction35 (95)51 (70)85 (77)0.003I do not think I have enough information about breat reconstruction35 (95)57 (78)92 (84)0.027I have never approached an NGO or civil society organizations to get a breast reconstruction37 (100)65 (89)102 (93)0.037I have never discussed with my partner about having a breast reconstruction30 (81)36 (49)66 (60)0.001
Citation Format: Paulina Bajonero-Canonico, Melina Miaja-Avila, José Moral de la Rubia, Jorge A Saldaña-Rodríguez, David E Hinojosa-González, Cristel G De la O-Maldonado, Cynthia M Villarreal-Garza. Information gaps and perceived barriers to achieve breast reconstruction among patients with mastectomy in a public breast cancer center in Mexico [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-15.