Not Receiving Lifesaving Cancer Treatment

Advanced breast cancer patients not receiving radiation after mastectomies

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Radiation following mastectomies is not usually recommended, except for patients with advanced or high-risk breast cancers. Yet most of these patients aren't receiving this potentially lifesaving treatment.

The University of Texas MD Anderson Cancer Center has uncovered a disturbing trend. Nearly half (45 percent) of the women who could benefit from radiation therapy following mastectomies aren't receiving the treatment.

This is happening despite the fact that postmastectomy radiation therapy (PMRT) has been proven to be potentially life-saving treatment for women with advanced or high-risk breast cancers.

"Radiation following mastectomies is recommended for advanced breast cancers."

Study author, Benjamin Smith, MD, assistant professor in the Department of Radiation Oncology at MD Anderson and lead author of the study, defined what's meant by advanced breast cancer. "In general, the patients with advanced, or high-risk, breast cancer in this study were patients with stage III breast cancer," Dr. Smith explained. "This generally means having at least 4 lymph nodes involved with cancer, a large tumor greater than 5 centimeters [2 inches in diameter] or a tumor growing into the skin of the breast or muscles of the chest."

Women with advanced breast cancer can benefit the most from PMRT, according to Dr. Smith, who doesn't understand exactly why they're not getting it. He says, though, that for some women, it can mean the difference between life and death.

Dr. Smith goes on to explain that women who receive PMRT tend to live longer and have less risk of the cancer returning than women who don't receive the therapy. "Women with stage III breast cancer who receive radiation after a mastectomy have about a 20 percent absolute decrease in risk of recurrence...and are also about 10 percent more likely to be alive ten years after treatment." Dr. Smith said.

The Surveillance, Epidemiology and End Results (SEER)- Medicare database was used to identify women age 66 and older who underwent mastectomy for invasive breast cancer between 1992 and 2005.

Researchers found that while women with high-risk cancers are not receiving postmastectomy radiation, women in the intermediate-risk category are actually having more PMRT, even though guidelines don't strongly recommend this course of treatment.

Dr. Smith offers a number of solutions for remedying the gap between evidence-based benefits and everyday clinical practice. He says, among other strategies, that physicians need to be more accountable for following the recommended guidelines.

The study is published in the journal Cancer.

Reviewed by: 
Review Date: 
June 27, 2011
Last Updated:
July 2, 2011