between 1998 and 2011, the percentage of women undergoing breast conserving therapy increased from 54.3% to 60.1%, the researchers found.
Most women diagnosed with breast cancer undergo any type of surgery, especially if the cancer is diagnosed in the early stages. Surgical options include mastectomy breast conservation therapy (BCT) and, or lumpectomy.
While mastectomy involves partial or total removal of the breast tissue, BCT involves only the removal of the chest containing the cancer.
There are pros and cons of each procedure. With a mastectomy, a woman may lose a whole breast, whereas women who undergo BCT may be able to retain most of their breast tissue – which is a preferable option for many. However, women who have often requires BCT Radiation therapy for about 5-6 weeks after surgery to ensure that any remaining cancer cells are destroyed.
In 1990, the National Institutes of Health (NIH) issued a consensus statement in support of BCT as a treatment option for breast cancers at an early stage, after a series of clinical trials demonstrated the efficacy of the procedure. As a result, rates of mastectomy reduced, while more women diagnosed with breast cancer in early stage chose to BCT.
However, the study authors – including Dr. Isabelle Bedrosian, the University of Texas MD Anderson Cancer Center in Houston – note that there have been many technical advances in the last 10 years that have led to more women with early stage breast cancer opting for mastectomy over BCT, despite being eligible for the latter procedure.
“These incentives include genetic testing for BRCA1 and BRCA2, advances in reconstruction techniques, magnetic resonance imaging of breast ( MRI ) and increased patient interest in contralateral prophylactic mastectomy,” the authors write.
For their study, Dr. Bedrosian and colleagues set out to identify BCT rates among women in the US diagnosed with breast cancer in early stage, and to determine what influences surgical decisions of women after a diagnosis of breast cancer.
Over 60% of women who opt for BCT, but remain barriers to treatment
The team used the National Cancer Data Base to identify 727.927 women who had been diagnosed with early-stage breast cancer and had undergone surgery for cancer between 1998 and 2011.
The researchers found that the percentage of women who chose BCT increased from 54.3% in 1998 to 60.1% in 2011. The increased use BCT was identified in all age groups.
Women 52-61 years of age were more likely to suffer BCT, the team found, as women with higher levels of education.
BCT rates were also found to be higher among women participating in the programs of academic cancer, those who lived in the northeastern US, and those who lived less than 17 miles from a cancer treatment plant .
BCT rates among women without not find health insurance to be lower compared with women who had private health insurance at 49.3% versus 62.3%. Women with the lowest average incomes were also less likely to suffer BCT.
While the study shows that the use of BCT increased during the period of 14 years, the authors say their findings reveal a number of factors continue to further restrict the use of the procedure:
“The disparities in the use of BCT based on age, geographic location and type of cancer program have improved since 1998. However, insurance, income and distance trip to persist treatment facilities as key barriers to BCT use. These socioeconomic barriers are unlikely to be suppressed without changes in health policies. “
In an editorial related to the study, Dr. Lisa A. Newman of the University of Michigan in Ann Arbor, he says that the findings of Dr. Bedrosian and colleagues demonstrate a “sad reality” that unequal access to care still influences health outcomes of patients.
“The conservative breast surgery optimal for most patients eligible lumpectomy requires a commitment to a whole-breast radiation, delivered in daily fractions over a period of 6 weeks,” he says. “However, this strategy requires access to a radiation oncologist and specialist treatment devices.”
“Patients who lack access daily transportation, patients who can not coordinate radiation treatments to work and / or responsibilities of child care, and patients who live far from one-sided irradiation facility barriers often insurmountable for search conservative breast surgery, even if they have a disease pattern that is ideal for this treatment, “he continues.
Dr. Newman points to 2010 and 2011 studies of the American College of Surgeons Oncology Group, demonstrating some long-term benefits of BCT, such as low rates of recurrence. However, it is observed that due to the barriers identified in this latest study, many patients may not benefit from BCT.
“Tragically, handicap, will continue to generate more disadvantaged,” he concludes.
Earlier this month, Medical News Today reported on a study that reveals many patients with breast cancer could be half the risk of a second surgical procedure for the disease if the surgeon removes more tissue during a lumpectomy.