Feature | February 11, 2015

Many Mastectomy Patients with Locally Advanced Breast Cancer Not Getting Post-Op Radiation

Study finds women more likely to get radiation therapy after receiving chemotherapy

breast cancer, radiation therapy, chemotherapy, mastectomy

February 11, 2015 — Breast cancer patients who undergo a mastectomy should receive subsequent radiation treatment if their cancer has spread to four or more nearby lymph nodes. However, according to a new study, only 65 percent of these women are getting the recommended postmastectomy radiation therapy (PMRT). The researchers looked at nearly 57,000 cases of breast cancer, and their study has been published as an "article in press" on the Journal of the American College of Surgeons website.

Several studies have found that PMRT reduces the risk of breast cancer recurrence and improves survival in patients whose cancer is "locally advanced" with a pathologic stage of N2 or N3 using the American Joint Committee on Cancer (AJCC) staging system. The AJCC defines N2 cancer primarily as having spread to between four and nine axillary, or underarm, lymph nodes but no other organs; N3 disease involves 10 or more axillary lymph nodes.

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

Since 2000, the National Cancer Institute and the American Society of Clinical Oncology have recommended PMRT, in addition to chemotherapy, for most breast cancer patients who opt for breast removal and have a high risk of tumor recurrence in the chest area. This risk group includes women with four or more positive (cancerous) lymph nodes. 

For this study, the investigators evaluated compliance with the treatment guidelines using the National Cancer Data Base (NCDB), a joint project of the American College of Surgeons Commission on Cancer (CoC) and the American Cancer Society.

From 2.72 million breast cancer cases diagnosed between 1998 and 2011 and listed in the database, 56,990 files of women with N2 or N3 cancer were found. The researchers evaluated these de-identified files to determine factors linked to receipt of PMRT. 

According to statistical analyses, only three factors independently predicted a higher likelihood that patients would receive PMRT: receipt of chemotherapy, readmission to the hospital within the first month after breast removal and being alive 30 days after the operation.

Women with N2 or N3 breast cancer were 5.4 times more likely to get radiation therapy after mastectomy if they also received chemotherapy. In all, 82.1 percent of patients received chemotherapy. Chu theorized that women who chose not to receive chemotherapy might also have been unwilling to accept radiation therapy.

Breast cancer patients had 1.14 times the odds of receiving PMRT if they were readmitted to the hospital within 30 days postoperatively because of complications or other reasons. Chu suggested that hospital care providers may realize that the patient was not referred for radiation therapy, making an early readmission "a point to remedy the error" of noncompliance with treatment guidelines.

"From this study, we could not tease out whether patients refuse treatment or there is a lack of awareness among women and physicians about the need for radiation therapy after mastectomy for locally advanced breast cancer," Chu said. "If women with N2/N3 breast cancer who plan a mastectomy are not offered PMRT, they should ask their physician why."

Exceptions to the PMRT recommendation for high-risk breast cancers include women who had prior radiation therapy or have connective tissue disorders.

For more information: www.facs.org

Related Content

ASTRO and ASCO Launch New Cancer Care Quality Registry
News | Radiation Therapy | January 22, 2018
January 22, 2018 — A registry that tracks the quality of medical care provided to patients receiving cancer treatment
First Hospitals Achieve Inter-System Connectivity Across Accuray Radiation Therapy Platforms
News | Radiation Therapy | January 19, 2018
Accuray Inc. announced recently that the Heidelberg University Hospital in Heidelberg, Germany, and Oscar Lambret...
RayStation Selected for New Carbon Ion Therapy Center in Japan
News | Treatment Planning | January 18, 2018
January 18, 2018 – RayStation has been chosen as the treatment planning system for a new carbon-ion therapy facility
Raysearch Receives First Order for the Raycare Oncology Information System
News | Oncology Information Management Systems (OIMS) | January 18, 2018
January 18, 2018 – Anderson Regional Cancer Center (ARCC) in Meridian, Mississippi, has placed the first order for...
Transpara Deep Learning Software Matches Experienced Radiologists in Mammogram Reading
News | Computer-Aided Detection Software | January 12, 2018
Deep learning and artificial intelligence improves the efficiency and accuracy of reading mammograms, according to...
Fat Distribution in Women and Men Provides Clues to Heart Attack Risk
News | Women's Health | January 11, 2018
January 11, 2018 – It’s not the amount of fat in your body but where it is stored that may increase your risk for hea
Women Prefer Getting Mammograms Every Year
News | Mammography | January 09, 2018
Women prefer to get their mammograms every year, instead of every two years, according to a new study presented at the...
Planmed Clarity 2-D Digital Mammography System Receives FDA Approval
Technology | Mammography | January 08, 2018
The U.S. Food and Drug Administration (FDA) issued an approval letter for the Planmed Clarity 2-D full-field digital...
Overweight Women May Need More Frequent Mammograms
News | Mammography | January 04, 2018
Women with higher body mass index (BMI) face an increased risk of not detecting their breast tumor until it has become...
Overlay Init