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Breast cancer: Why aren't 45 percent of women getting lifesaving treatment?

Kathleen Blanchard's picture
PMRT and breast cancer

An investigation shows potentially lifesaving radiation treatments aren't given to almost half of women with advanced breast cancer, despite evidence based guidelines that have existed since 1999.

Radiation treatment important after mastectomy for high risk patients, but not being delivered

The reasons are unclear to researchers who discovered the gap in breast cancer treatment from the Surveillance, Epidemiology and End Results (SEER)-Medicare database.

Researchers identified women age 66 and older who underwent mastectomy for invasive breast cancer between 1992 and 2005, finding 5000 women diagnosed with the disease - but just over half (55 percent) with high risk disease received post mastectomy radiation treatment (PMRT).

The finding also found radiation treatment for women with intermediate risk breast cancer increased, even though there are no strong guidelines recommending PMRT for patients with moderate disease.

The study, published in the July issue of Cancer, raises questions about why radiations guidelines for breast cancer treatment aren't being followed.

Benjamin Smith, M.D., assistant professor in the Department of Radiation Oncology at MD Anderson and lead author of the study says, “There’s a clear gap between the scientific evidence demonstrating PMRT’s benefits and the proper use of the therapy in everyday clinical practice.”

Three studies, published from 1995 to 2002, showed radiation after breast removal improves survival and prevents recurrence.

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The research was published by the National Cancer Institute, the American Society for Clinical Oncology and the National Comprehensive Cancer Network, establishing guidelines for clinicians based; on the study evidence.

Smith says there is a need to develop strategies that bring clinical evidence into the practice. Suggestions to ensure women are getting radiation after breast cancer surgery include adding PMRT compliance to physicians’ accreditation process, which would be tracked by medical organizations like the American College of Surgeons Commission on Cancer and the National Quality Forum. Another proposal from Smith is financial incentives from large payer networks and use of electronic medical records by government organizations to measure quality and compliance.

Smith also suggests groups like the American Society for Therapeutic Radiology and Oncology (ASTRO) and the American Society for Clinical Oncology (ASCO) should promote the use of post mastectomy radiation therapy guidelines among its members.

He says, “While we need to identify and correct the treatment barriers, physician accountability is necessary to ensure women receive optimal care. For some patients, it can be the difference between life and death”.

He adds, women with advanced breast cancer just aren’t getting the benefits of PMRT, “for some reason”, but understanding why may need more research. Other possibilities as to why the problem exists are lack of radiation oncology providers or transportation issues.

The finding from the analysis showed just 45 percent of women with high risk breast cancer get radiation after cancer surgery, even though the therapy is part of clinical guidelines for treating the disease. Paradoxically, use of PMRT increased among women with less risky breast cancer during the study period.

Shirvani, S. M., Pan, I.-W., Buchholz, T. A., Shih, Y.-C. T., Hoffman, K. E., Giordano, S. H. and Smith, B. D. (2011), Impact of evidence-based clinical guidelines on the adoption of postmastectomy radiation in older women. Cancer, 117: n/a. doi: 10.1002/cncr.26081

Image credit: Wikimedia Commons