While radiation therapy is common after breast conserving surgery, it’s much less frequent after mastectomy, even among women for whom it would have clear life-saving benefit. This is according to a new study from researchers at the Comprehensive Cancer Center.
The study looked at 2,260 women treated for breast cancer, assessing whether they had lumpectomy or mastectomy, and whether they would be strong candidates for radiation therapy. Women who have particularly large tumors or cancer in four or more of their nearby lymph nodes are recommended to have radiation after mastectomy.
The study found that among patients who should receive radiation therapy according to medical guidelines, 95 percent of those who had lumpectomy went on to receive radiation, but only 78 percent of those who had mastectomy received radiation. Among women for whom radiation is less clearly beneficial, 80 percent of the lumpectomy patients had radiation while only 46 percent of the mastectomy patients did.
“A substantial number of breast cancer patients are being undertreated. One in five women with strong indications for radiation after mastectomy failed to receive it. Radiation can be a life-saving treatment,” says study author Dr. Reshma Jagsi, assistant professor of radiation oncology at the Medical School.
“The fact that 95 percent of patients who had lumpectomy received radiation in the two metropolitan areas we studied indicates that we can do better than we are currently doing for the selected mastectomy patients who also need radiation. More attention needs to be paid to radiation after mastectomy,” Jagsi says.
Results of the study appear online in the Journal of Clinical Oncology.
The study also found that doctor participation strongly influenced radiation receipt. Patients who reported their surgeon was involved in the decision to receive radiation were more likely to receive radiation than patients whose doctor was less involved.
“Even patients who wanted to avoid radiation therapy were very likely to receive it if their surgeons were highly involved in the decision process. We need to do a better job of educating both patients and physicians regarding the benefits of radiation after mastectomy in certain circumstances, and we need to encourage physicians to help their patients as they make these important decisions,” Jagsi says.
In patients with strong indications for radiation after mastectomy, their risk of the cancer coming back in the chest wall or surrounding areas can exceed 30 percent. This is reduced by two-thirds if the patient undergoes radiation treatments, and overall survival is improved.
Additional U-M authors are Paul Abrahamse, Sarah Hawley, Dr. Jennifer Griggs and Dr. Steven Katz, all of the Comprehensive Cancer Center.
