Breast cancer patients not getting recommended radiation therapy: Report

By Dr. Ananya Mandal, MDJun 28 2011

According to a report released Monday in the journal Cancer, nearly half of older women with advanced stage breast cancer who undergo a mastectomy don't receive radiation therapy, despite guidelines that say it can save lives.

For their report the researchers from MD Anderson Cancer Center in Houston looked at data for more than 38,000 women age 66 and older who underwent a mastectomy after a breast cancer diagnosis between 1999 and 2005. Nearly 8,000 of whom had an advanced form of the disease. They write that although major guidelines released during the six-year period recommended radiation therapy after mastectomy for women with advanced forms of the disease, nearly half of the women whose records the researchers analyzed during that period did not receive the therapy.

Dr. Benjamin Smith, assistant professor of radiation oncology at MD Anderson Cancer Center, and co-author of the study said some women may have opted out of radiation therapy. The women who were less likely to receive radiation were over age 80, suggesting that some of the women may have favored quality of life over duration of life. However Smith added that the results suggest a disconnect between knowing what recommended guidelines state and following them. He said, “Historically, radiation therapy was not thought to be helpful after mastectomy. So this bias against radiation after a mastectomy still probably exists to a certain extent.”

There are two potential problems when doctors don't follow guidelines, the authors wrote. One is that patients don't get evidence-based treatment. Second, patients may instead get ineffective treatments or tests instead. From 1996 and 1998, the rates of radiation following mastectomy for women ages 66 and older increased from 36.5% to 57.7%. But in a review of data from 1998 to 2005, these researchers found no further increase.

Nearly half of older women with advanced stage breast cancer who undergo a mastectomy don't receive radiation therapy despite guidelines that radiation after a mastectomy can save lives.