Recently New York State has mandated a discussion of options for patients with Breast Cancer. Since my training at Sloan Kettering in New York I could not conceive of a woman not being offered the options of breast reconstruction when told of their diagnosis. A New York Times excerpt follows.
Before Breast Is Removed, a Discussion on Options
By ANEMONA HARTOCOLLIS
Published: August 18, 2010After her mastectomy in April, Alantheia Pena cried for the loss of her breast. Her partner told her not to worry about the flat spot on her chest, but she could tell it bothered him when he looked away as she took off her shirt.
It was a kindly secretary at the place where she went to get her prosthesis, an artificial breast to fill out her clothing, who noticed her crying and told her that she could have her breast reconstructed, with health insurance covering the cost. Ms. Pena said her cancer surgeon had not told her.
Now a state law signed on Sunday by Gov. David A. Paterson will require New York hospitals and doctors to discuss the options for breast reconstruction with their patients before performing cancer surgery, to give them information about insurance coverage and to refer them to another hospital, if necessary, for the reconstructive surgery.
The law came about largely through the efforts a plastic surgeon at Montefiore Medical Center in the Bronx who gave Ms. Pena, who will turn 48 next week, a new breast, which made her so happy she wore a bikini last month for the first time in her life.
“It gave me back my life,” Ms. Pena, who runs the H.I.V. ministry at Friendship Baptist Church in Brooklyn and lives in the Bronx, said on Wednesday. “It’s like my own breast. It’s beautiful. It’s perfect. It’s a perfect breast.”
Dr. Garfein, who specializes in reconstructive surgery after breast, head and neck cancer, said he had pushed for the law after a friend of his, Dr. Caprice Christian Greenberg, co-wrote a paper showing that poor, minority women were much less likely to receive breast reconstruction after cancer than more affluent women.
Congress guaranteed universal coverage for breast reconstruction after cancer surgery in 1998. Only 30 percent to 40 percent of the women who had mastectomies now received breast reconstruction.
The number would be closer to 75 percent if more women were informed of their options. Ms. Pena, had her surgery at North General Hospital in Harlem, which is defunct, but she said her doctor there had never discussed breast reconstruction with her.
One reason for the low rate of reconstruction, Dr. Garfein said, may be the lack of plastic surgeons outside of large academic medical centers, and another may be financial.
Ms. Pena is still recovering from cancer, but with her new breast, she said, “at the end of it, you see some kind of rainbow.”
Available every week to fit in breast reconstruction consults to discuss options. Larry Weinstein MD FACS www.drlarryweinstein.com
ScienceDaily (Dec. 17, 2009) — Time and time again, it has been documented that regular exercise has many health benefits including lowering risks associated with the comorbidities of obesity. With only 30% of Americans trying to lose weight meeting the National Institutes of Health exercise guidelines of 300 minutes/week, a study in the January/February 2010 issue of the Journal of Nutrition Education and Behavior explores the paradox that exists -- an antidote for obesity and its comorbidities is exercise, but the majority of obese Americans do not exercise. Investigators explore and compare the barriers associated with regular exercise in health clubs between overweight and normal weight individuals.
Researchers at The George Washington University Medical Center examined overweight individuals' intent to exercise at health clubs by administering an online survey instrument based on Ajzen's Theory of Planned Behavior. This theory is based on
- one's attitude toward the behavior in question,
- the perceived social pressure (subjective norm) to perform the behavior, and
- the ease or difficulty with which one can actually perform the behavior (perceived control).
Of the 1,552 individuals surveyed, 989 were classified into the overweight category.
The researchers found overweight individuals believed exercise improved appearance and self image more than normal weight individuals. In addition, overweight individuals felt more embarrassed and intimidated about exercising, exercising around young people, exercising around fit people, and about health club salespeople than individuals of normal weight. Overweight and normal weight individuals felt the same about exercising with the opposite sex, complicated exercise equipment, exercise boredom, and intention to exercise. The study interestingly found that the demographics of older age and overweight Caucasians (versus overweight non-Caucasians) had more of an effect on exercise intent than did weight. Most notably, the heavier the subject's weight, the lower his or her perception of health. In other words, for the overweight, sedentary person, the negative emotions associated with health club exercise may be stronger in controlling regular exercise than the intellectual facts.
Writing in the article, the authors state, "One of the most noteworthy findings of this study was that OW [overweight] and NW [normal weight] subjects did not differ in their overall attitude toward exercising at a health club. This similarity in overall attitude of the OW and NW to club exercise is somewhat surprising, in that it is often assumed that OW people do not exercise as much as NW people because the 2 groups have different attitudes about exercise.
The behavior theories that propose that attitude drives the intent to exercise describe attitude as an evaluation of positive versus negative. If this is the case, then, it is important to minimize the negative and maximize the positive in order to promote the desired behavior. Thus, it would be wise for exercise professionals and commercial health clubs to help OW people feel more comfortable around those who are different from themselves and to minimize the intimidating aspects of the exercise environment, while promoting the benefits of exercise to personal health and wellbeing.
Regardless of which subset of the OW population is the target for increasing health club exercise, the ultimate goal is to increase the number of positive beliefs the individual has concerning exercising in a health club…Accordingly, individual beliefs about health club exercise should be evaluated for each new client. If a plan to increase the positive beliefs and reverse the negative beliefs is constructed and followed, the likelihood of retention of that client will be augmented."
Note: Diet and exercise are more important than liposuction for good looks and good health. Larry Weinstein, MD FACS
