Lumpectomy Should Be Offered to Older Women

A new study by researchers at the University of Texas M.D. Anderson Cancer Center in Houston has found that breast conservation surgery (lumpectomy) is equally effective for older women with early stage breast cancer as it is for younger women. Unfortunately, many older women are not offered this less-aggressive treatment alternative.

Writing in the journal Cancer, Dr. Georges Vlastos and colleagues noted that far too many older women are automatically given mastectomies "based largely on patient and physician biases," including a perception that older women do not have the same cosmetic concerns as younger women.

Furthermore, they pointed out, even when older women do receive more conservative surgery, they often do not get crucial additional therapy such as radiation that greatly minimizes the chance for recurrence.

Vlastos' team reviewed the records of 184 women over age 65 who had breast conservation therapy at M.D. Anderson between 1970 and 1994. They found that only 5 percent of the patients had tumors recur in the same region, while 11 percent later developed cancer in distant sites of the body. More than 80 percent of the women were disease-free five years after treatment.

"These outcomes," they wrote, "are comparable to those found in similarly treated groups of younger women." They urged both patients and physicians to base treatment decisions on the individual circumstances of the patient rather than their age. "Older women have the same rights as their younger counterparts to be informed fully about all available treatment options," they wrote.

Uneven Care

An earlier study released by Solucient Leadership Institute (formerly the HCIA-Sachs Institute) found that breast cancer patients being treated at top medical centers are more likely to undergo breast-conserving surgery than patients at other hospitals.

The study, entitled "100 Top Hospitals' Clinical Research Program: Management of Breast Cancer," examined how top-performing hospitals compare with other hospitals in three areas: use of breast-conserving surgery; use of radiation therapy following breast-conserving surgery; and the performance of immediate breast reconstruction following mastectomy.

"Overall, the rates we found of breast-conserving surgery are lower than we expected," said the study's research consultant, Kathryn Rexrode, M.D., an associate physician in women's health at Brigham and Women's Hospital, Boston, and an instructor at Harvard Medical School. "The results suggest that we need to be sure women are given treatment choices they can consider in the context of their unique personal and clinical factors."

The study also found that:

• Compared to patients in the Northeast, women in the South are 21 percent less likely to receive breast-conserving surgery, and women in the West are 17 percent less likely.
• Forty-six percent of Hispanic women undergo breast-conserving surgery, compared to 47.5 percent of African-American women, 48.5 percent of Asian Americans, and 51.1 percent of Caucasians.
• Women insured by Medicaid are 69 percent less likely than privately insured patients to receive immediate breast reconstruction following mastectomy.
• Immediate reconstructive surgery following mastectomy is more common in top-performing hospitals and teaching hospitals compared to community hospitals.
• When it comes to radiation therapy following breast-conserving surgery, patients are most likely to undergo this treatment in top-performing hospitals, as well as in hospitals in the Western region; moreover, younger patients are more likely than older patients to receive post-surgery radiation.

"The good news is that top-performing hospitals are clearly leading the industry in providing more progressive initial treatment and follow-up of breast cancer," said Jean Chenoweth, the institute's executive director.

"However, an additional area of concern identified in this study is that women on Medicaid are significantly less likely to have immediate reconstructive surgery than privately insured women," Chenoweth added. "This underscores the fact that women with breast cancer may not be offered the same options, and that some treatment may not reflect best practice and follow-up care."

SOURCE:
Cancer, September 2001; 92:1092-1100
University of Texas, M.D. Anderson Cancer Center (http://www.mdanderson.com)
"100 Top Hospitals' Clinical Research Program: Management of Breast Cancer," The Solucient Leadership Institute (http://www.TopHospitals.com)

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