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

Clinical Trial Testing Topical Gel to Reduce Breast Density
News | Breast Density | June 19, 2018
Women with dense breast tissue soon might be adding a new product to their skincare routine to help them fight breast...
New Prostate Cancer Radiotherapy Technique Aims to Preserve Sexual Function
News | Radiation Therapy | June 18, 2018
A multicenter clinical trial being led by UT Southwestern physicians is testing a technique for sparing nerve bundles...
Elekta Unity High-Field MR-Linac Receives CE Mark
News | Image Guided Radiation Therapy (IGRT) | June 18, 2018
Elekta announced that its Elekta Unity magnetic resonance radiation therapy (MR/RT) system has received CE mark,...
California Women In Favor of Extending State's Breast Density Inform Law
News | Breast Density | June 15, 2018
A recent survey of California women found that 95 percent of respondents want the state’s breast density inform law to...
Washington University in St. Louis Begins Clinical Treatments With ViewRay MRIdian Linac
News | Image Guided Radiation Therapy (IGRT) | June 14, 2018
June 14, 2018 — The Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in S
Accuray TomoTherapy System Beneficial in Two Total Body Irradiation Studies
News | Radiation Therapy | June 13, 2018
Recently published data from two new studies demonstrate the benefits of Accuray’s TomoTherapy System in the delivery...
Women More Likely to Use Other Preventive Health Services Following Mammography
News | Mammography | June 13, 2018
Medicare beneficiaries who undergo breast cancer screening with mammography are more likely than unscreened women to...
IsoRay Funding Brain Cancer Treatment Research With Ochsner Clinic Foundation
News | Brachytherapy Systems | June 12, 2018
IsoRay Inc. announced the initiation of research funding for brain cancer treatment to Ochsner Clinic Foundation, a not...
How AI and Deep Learning Will Enable Cancer Diagnosis Via Ultrasound

The red outline shows the manually segmented boundary of a carcinoma, while the deep learning-predicted boundaries are shown in blue, green and cyan. Copyright 2018 Kumar et al. under Creative Commons Attribution License.

News | Ultrasound Imaging | June 12, 2018 | Tony Kontzer
June 12, 2018 — Viksit Kumar didn’t know his mother had...
News | Brachytherapy Systems | June 07, 2018
IsoRay Inc. announced the upcoming release of its Build-Blu delivery system for real-time prostate brachytherapy.
Overlay Init