Fewer women with early-stage breast cancer are receiving appropriate primary therapy today than a decade ago, according to an analysis of national data collected by the National Institutes of Health (NIH).
The reason is the growing popularity of lumpectomy, where
doctors cut out only the cancerous part of the breast instead of
removing the whole breast, and the failure of some doctors to carry
out important follow-up treatments, said the study, published this
week in The Lancet.
Two treatment options are considered appropriate when breast
cancer has not spread to other areas. The first is a mastectomy--
the removal of the breast with a dissection of the lymph
nodes in the armpit to ensure they are cancer free.
The second is a lumpectomy, along with the lymph node check and
radiation treatment of the area. Although it allows women to keep
their breasts and can be as effective at eliminating cancer if done
right, lumpectomy is a more complicated treatment than mastectomy.
The problem noted by researchers from the Medical College of
Wisconsin in Milwaukee was that some doctors skipped the radiation
or lymph node inspection, or both, when they performed
lumpectomies. Breast conservation requires a separate incision for axillary lymph-node dissection, postoperative radiotherapy, attention to the tumour margins, and attention to the cosmetic result.
It estimated that about 22,000 American women each year may be
receiving substandard care. Dr. Ian Fentiman, a professor of oncology at Guy's Hospital in London, said a similar trend of substandard lumpectomies was seen
In the study, the scientists examined the medical records of
144,759 women aged 30 and older who had surgery in the United
States for early-stage breast cancer between 1983 and 1995.
The researchers found that the proportion of women getting
substandard lumpectomy treatment increased from 10 percent in 1989
to 19 percent at the end of 1995.
The researchers note that in 1990, an NIH Consensus Statement defined the minimum appropriate primary treatment for early-stage breast cancer as either total mastectomy with axillary node dissection or breast-conserving surgery with axillary node dissection and radiotherapy.
The authors stress that the increase in inappropriate care occurred only among women who received breast-conserving therapy. In general, breast-conserving treatment was inappropriate because it was incomplete, missing either radiation therapy or axillary lymph node dissection, or both.
Dr. Nattinger and her team note that the decline in appropriate treatment occurred in all subgroups of women by age, disease stage and race.