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Although more older women receive
breast-conserving therapy, gaps in treatment
exist
New study in Journal of the American College
of Surgeons finds geography, education and
economic status affect treatment for early
invasive breast cancer
CHICAGO (October 9, 2009) – According to a
new study published in the October issue of
the Journal
of the American College of Surgeons,
although breast-conserving surgery (BCS),
commonly known as lumpectomy, is
increasingly being used to treat older women
with nonmetastatic invasive breast cancer,
there are still significant socioeconomic
and geographic disparities in the use of
this type of therapy.
For example, women in the Northeast and
Pacific West are significantly more likely
to receive BCS than those in the South and
parts of the Midwest.
In BCS, only a part of the affected breast
is removed, whereas a mastectomy involves
removing all of the breast tissue, sometimes
along with other nearby tissues.
Combined with radiotherapy, BCS is as
effective as a mastectomy for treatment of
early invasive breast cancer.
Yet despite the large body of evidence
supporting the efficacy of BCS, studies
conducted in the last two decades reported
that less than half of all surgically
treated patients with nonmetastatic invasive
disease received BCS.
"Treatment of nonmetastatic invasive breast
cancer has improved significantly over the
past several decades, but we continue to
fall short of the goal to treat every woman
with the highest quality care," said Grace
L. Smith, MD, PhD, Postdoctoral Fellow,
Department of Radiation Oncology, The
University of Texas M. D. Anderson Cancer
Center.
"Our study suggests that barriers exist that
may prevent many women with breast cancer –
especially those in poorer areas, areas with
low education levels, rural communities and
counties with few radiation oncologists –
from being offered every treatment option
that should be available to them."
Using a national Medicare database,
researchers identified women age 65 years
and older who were surgically treated in
2003 for invasive breast cancer. Claims
codes identified demographic, treatment and
geographic region covariates. The 2003 Area
Resource File provided socioeconomic data.
Of 56,725 women in the database, 59 percent
were treated with BCS versus 41 percent with
mastectomy.
BCS was more widely used in women who were
younger than 70 years (odds ratio [OR],
1.37; p<0.001) and had lymph node-negative
disease (OR, 1.60; p<0.001).
The results showed that socioeconomic and
demographic factors influenced the type of
surgical procedure, with BCS more prevalent
in areas with low poverty (OR, 1.05;
p=0.03), high education (OR, 1.13; p<0.001)
or a high density of radiation oncologists
(OR, 1.30; p=0.01), and in metropolitan
areas (OR, 1.20; p<0.001).
Results also revealed disparities between
geographic regions. Patients in the
Northeast and Pacific West were the most
likely to undergo BCS (around 79 percent and
71 percent, respectively), while patients in
the South and portions of the Midwest were
the least likely (57 to 59 percent and 58
percent, respectively).
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