Study Finds One-Third of Mastectomy Patients With Locally Advanced Breast Cancer Do Not Get Recommended Radiation

Researchers were not sure whether breast cancer patients were refusing radiation or whether women and their physicians have a lack of awareness of its importance after a mastectomy.

When breast cancer patients received a mastectomy, they should also receive radiation after surgery if their cancer has spread to 4 or more nearby lymph nodes. However, a forthcoming study to be published in the Journal of the American College of Surgeons found that only 65% of these women are receiving the recommended radiation.

The study, just featured as an “article in press” on the journal’s website, is based on an evaluation of 57,000 cases of breast cancer. A press release issued by the American College of Surgeons noted that studies have found postmastectomy radiation therapy (PMRT), reduces the risk of breast cancer recurrence and increases survival in patients with a pathologic stage of N2 or N3, based on the American Joint Committee on Cancer staging system.

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

The National Cancer Institute and the American Society of Clinical Oncology have recommended PMRT in addition to chemotherapy for these patients since 2000.

For the study, researchers evaluated compliance with guidelines using patient data in the National Cancer Data Base, a joint project of the American Cancer Society and the American College of Surgeons’ Commission on Cancer (CoC). This database captures an estimated 70% of newly diagnosed cases in the United States, from 1500 CoC accredited programs.

Researchers did not find that factors such as race or ethnicity, income, education level, health insurance status, place of residency, or comorbidity influenced whether a woman received radiation. Also, the type of treatment facility—community cancer center vs. academic center, for example—did not seem to affect the outcome. However, most patients in the study were white, had private insurance, higher incomes, and lived in metropolitan areas.

The only factors that corresponded with higher likelihood of radiation were: receiving chemotherapy, readmission to the hospital within 30 days after breast removal, and being alive 30 days after the operation. Those with N2 or N2 breast cancer were 5.4 times likely to get radiation therapy if they also had chemotherapy. Chu said that it is possible that women who did not receive chemotherapy may have also been unwilling to accept radiation.

Being readmitted soon after breast removal may have offered healthcare providers an opportunity to realize that the patient had not been referred for radiation, researchers said. They said they could not “tease out” whether patients are refusing radiation, or whether there is a lack of awareness among women and physicians about its importance after a mastectomy.