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Many Mastectomy Patients With Locally Advanced Breast Cancer Do Not Get Post-Op Radiation

Study finds this gap in the standard of care is unrelated to socioeconomic factors

Only 65% of breast cancer patients who undergo a mastectomy and whose cancer has spread to four or more nearby lymph nodes are receiving the recommended radiation treatment that should follow, according to a new study.

The researchers looked at nearly 57,000 cases of breast cancer, and their study has been published as an “article in press” on the website of the Journal of the American College of Surgeons in advance of print publication this spring.

Several studies have found that postmastectomy radiation therapy (PMRT) reduces the risk of breast cancer recurrence and improves survival in patients whose cancer is “locally advanced” with a pathological stage of N2 or N3 using the American Joint Committee on Cancer (AJCC) staging system. The AJCC defines N2 cancer primarily as having spread to between four and nine axillary lymph nodes but no other organs, and N3 disease involves 10 or more axillary lymph nodes.

“My colleagues and I were quite startled by the finding that a third of patients with N2/N3 disease did not receive PMRT, which is the standard of care,” said lead author Quyen D. Chu, MD, MBA, FACS, Professor of Surgery at Louisiana State University Health Sciences Center in Shreveport.

Since 2000, the National Cancer Institute and the American Society of Clinical Oncology have recommended PMRT, in addition to chemotherapy, for most breast cancer patients who opt for breast removal and have a high risk of tumor recurrence in the chest area. This risk group includes women with four or more positive (cancerous) lymph nodes.

For this study, the investigators evaluated compliance with the treatment guidelines using the National Cancer Data Base (NCDB), a joint project of the American College of Surgeons Commission on Cancer (CoC) and the American Cancer Society. NCDB captures an estimated 70% of newly diagnosed cancer cases in the United States from approximately 1,500 cancer programs accredited by the CoC.

From 2.72 million breast cancer cases diagnosed between 1998 and 2011 and listed in the database, 56,990 files of women with N2 or N3 cancer were found. The researchers evaluated these de-identified files to determine factors linked to receipt of PMRT.

Dr. Chu and colleagues found those patients’ socioeconomic characteristics — such as race or ethnicity, income or education level, health insurance status, residential location, or comorbidity — did not influence whether women with N2 or N3 breast cancer received PMRT. Likewise, neither did the geographic region of the treatment facility nor its type of cancer program (community cancer program, larger comprehensive community cancer program, academic cancer research program, or other type). However, most study patients were white, had private insurance, had a high income and educational level, and lived in a large metropolitan area.

According to statistical analyses, only three factors independently predicted a higher likelihood that patients would receive PMRT: receipt of chemotherapy, readmission to the hospital within the first month after breast removal, and being alive 30 days after the operation.

Source: American College of Surgeons; February 9, 2015.

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