Breast cancer survivors at back of queue

Annette Tupaea

Women who have survived breast cancer are not getting beneficial breast reconstructions because high demand and a lack of resources in public hospitals mean they are not an immediate priority.

A prominent breast surgeon is furious at the development, saying the surgery plays an important part in a woman's recovery.

Dr Belinda Scott, who also chairs the Breast Cancer Foundation's medical committee, has been told that one district health board, Hutt Valley's, is this week sending out letters informing women on its waiting list for reconstruction that they are being dropped because they cannot be seen within six months.

This follows similar moves by the Canterbury and Waikato district health boards, she said.

Only four district health boards - Counties Manukau, Waikato, Canterbury and Hutt Valley - perform breast reconstructions.

Done privately, they cost upwards of $20,000.

"This is, of course, how you make the waiting lists go away. You say if it's not done within six months, it won't be done at all."

Dr Scott said Middlemore Hospital's plastics unit is treating patients with "burns from P labs that have blown up" and nose fractures from rugby accidents, but delayed breast reconstruction was treated as "by-the-by".

"It just absolutely infuriates me."

While the preferred option was for patients to have the affected breast removed and reconstructed at the same time, it was not always possible.

Dr Scott said radiotherapy, which is being used more often now to treat breast cancer, should not be combined with reconstructive surgery, making a delay necessary.

"The benefit for the patient is better treatment, but the disadvantage for the patient now is that they will probably not get reconstructive surgery in the public system and most of them can't afford it [privately]."

It was a procedure beyond aesthetics, said Dr Scott.

"It's about how you feel about yourself. When you wake up in the morning and you see a flat chest, you're always reminded you had breast cancer.

"If you can wake up and have something there that looks like a breast, it just takes away that reminder that you've had breast cancer.

"For young women, particularly, it's an important part of their healing process."

Dr Stephen Mills, a plastic surgeon in both private and public practice, said there was also a functional aspect.

"They [patients] may have had a prosthesis, but they just find it doesn't work for them. It's hard getting T-shirts to fit properly and it's hard when you go swimming. It's hard because your kids say, 'mummy, why have you only got one breast?'

"Reconstruction should be available to these women in the public sector and the private sector, and the number of delayed reconstructions has just fallen away dramatically."

The Ministry of Health's chief medical adviser, Dr David Geddis, said it has not issued specific directives on managing patients awaiting breast reconstruction surgery, although letters have been sent to all district health boards about managing elective services within available resources.

"It's about firstly being up-front with patients about whether they will get a service within six months and secondly fairness, ensuring that we treat patients in order of clinical priority."

Women will continue to get breast reconstruction surgery through the public health system, he said.

"It's according to clinical priority. Whatever plastic surgery services district health boards decide are high priority get done."

Counties Manukau's general manager for surgical care, Chris Fleming, said Middlemore Hospital does under 24 breast reconstructions a year.

Its plastic unit was also facing a staff shortage, with seven plastic surgeons instead of the 11 needed, said Mr Fleming.

It was in talks to re-establish national priorities for plastic surgery.

$30,000 MONEY WELL SPENT

Breast-cancer survivor Annette Tupaea has no regrets about opting for reconstructive surgery.

Diagnosed with the more aggressive form of lobular cancer in 2002, she was advised by her surgeon to remove the affected breast. She chose to have both removed.

Even though her surgeon was comfortable with the procedure, the Manukau accountant knows it was a drastic decision.

But she had read up on it, and knew that with her form of cancer, there was a high risk of it developing in the other breast as well. She would be proven right, as her other breast was later found to have cancerous cells.

That June, she underwent a double mastectomy and reconstructive surgery at the same time.

The procedure took six hours, three surgeons - two plastic surgeons and a breast surgeon - and a week's stay at the Ascot Hospital in Greenlane.

All up it cost her nearly $30,000.

Mrs Tupaea went private - "only because I was able to" - rather than endure a wait in the public system.

"It is a lot, but I certainly don't regret it. I can wear things like T-shirts now without worrying about a prosthesis."

She knows of a friend in a similar predicament who has regretted not getting reconstruction.

"For me, to be able to have woken up from the surgery and still have breasts meant heaps to me. I still felt as if they were my breasts, nothing had changed. I still felt womanly.

"People just look at me, and they can't believe that I've actually had breast cancer or anything like that. They wouldn't even know if they didn't know me."