By Laura Sussman, Staff Writer
While older women with early invasive breast cancer are increasingly undergoing breast conserving surgery (BCS), commonly known as lumpectomy, significant socioeconomic and geographic disparities still preclude some from receiving the therapy, according to a study published in the Journal of the American College of Surgeons.
Led by Grace Li Smith, M.D., Ph.D., a postdoctoral fellow in M. D. Anderson's Department of Radiation Oncology, the study compares the use of lumpectomy to that of the other surgical option available to women with early invasive disease, mastectomy.
Combined with radiation, lumpectomy has proven to be as effective as a mastectomy for the treatment of early invasive breast cancer, yet previous studies have reported that less than half of all patients eligible receive this option, said Smith.
"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 of care," said Smith. "Our study suggests that barriers exist that may prevent may 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 that should be available to them."
For the retrospective study, Smith and her M. D. Anderson colleagues used Medicare claims to examine the treatment history of women 65 and older who were surgically treated for invasive breast cancer in 2003.
Of the 56,725 women identified, 59 percent underwent a lumpectomy, compared to 41 percent who received mastectomy. BCS was used most frequently in women younger than 70 and had no lymph node involvement. In contrast to mastectomy, the study also found BCS more prevalent in areas with low poverty, high education, a high population of treating radiation oncologists and/or in larger metropolitan areas. Looking at geographic regions, the researchers found that women in the Northeast and Pacific West were most likely to receive the procedure, while the South and parts of the Midwest were the least likely.
Smith hopes that results from the study may prompt physicians and patients to work together to overcome some of the barriers to treatment.
"Physicians may be able to help women identify specific barriers to their care and be influential in helping patients overcome such obstacles," suggested Smith. "Or, if there are concerns or misconceptions about surgical options, patients themselves may play a role by becoming educated about the value of lumpectomy as an appropriate therapy, and helping to disseminate this information into their communities."
While older women with early invasive breast cancer are increasingly undergoing breast conserving surgery (BCS), commonly known as lumpectomy, significant socioeconomic and geographic disparities still preclude some from receiving the therapy, according to a study published in the Journal of the American College of Surgeons.
Led by Grace Li Smith, M.D., Ph.D., a postdoctoral fellow in M. D. Anderson's Department of Radiation Oncology, the study compares the use of lumpectomy to that of the other surgical option available to women with early invasive disease, mastectomy.
Combined with radiation, lumpectomy has proven to be as effective as a mastectomy for the treatment of early invasive breast cancer, yet previous studies have reported that less than half of all patients eligible receive this option, said Smith.
"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 of care," said Smith. "Our study suggests that barriers exist that may prevent may 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 that should be available to them."
For the retrospective study, Smith and her M. D. Anderson colleagues used Medicare claims to examine the treatment history of women 65 and older who were surgically treated for invasive breast cancer in 2003.
Of the 56,725 women identified, 59 percent underwent a lumpectomy, compared to 41 percent who received mastectomy. BCS was used most frequently in women younger than 70 and had no lymph node involvement. In contrast to mastectomy, the study also found BCS more prevalent in areas with low poverty, high education, a high population of treating radiation oncologists and/or in larger metropolitan areas. Looking at geographic regions, the researchers found that women in the Northeast and Pacific West were most likely to receive the procedure, while the South and parts of the Midwest were the least likely.
Smith hopes that results from the study may prompt physicians and patients to work together to overcome some of the barriers to treatment.
"Physicians may be able to help women identify specific barriers to their care and be influential in helping patients overcome such obstacles," suggested Smith. "Or, if there are concerns or misconceptions about surgical options, patients themselves may play a role by becoming educated about the value of lumpectomy as an appropriate therapy, and helping to disseminate this information into their communities."
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