Radiation treatment after a mastectomy for advanced breast cancer is part of the standard treatment guidelines. In the mid-1990s, several studies (Huang Study) concluded that mastectomy patients with advanced breast cancer have better outcomes if they undergo radiation after surgery. Initially, the medical community seemed to pay attention to the findings. As a result four organizations had issued guidelines about the value of radiation after mastectomy from 1999 to 2001: the American Society for Therapeutic Radiology and Oncology, the American Society of Clinical Oncology, the National Institutes of Health, and the National Comprehensive Cancer Network. 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, researchers from MD Anderson Cancer Center in Houston found no further increase. But more than a decade after the lifesaving value of radiation was confirmed, about half of all women who should get radiation therapy aren’t getting it.
The new study, published in the journal Cancer, finds that 45.2% of older women found to have high-risk breast cancer between 1999 and 2005 did not receive additional post-mastectomy radiation treatment, despite the publication of major guidelines recommending the therapy. High risk patients were defined as Stage 3 breast cancers, patients with tumors 5 centimeters or larger and those where the tumor had spread to four or more lymph nodes.
What the study also found was that women who live in areas with a lot of radiation oncologists were 20% more likely to get radiation than women who did not. They contribute this to the particular challenge of older patients in getting daily radiation treatment for five or six weeks, especially those living in rural areas with limited access to transportation.
It is important for patients to have a discussion with their physician about the possibility of recurrence without radiation. It is important that the oncologist and breast surgeons have these challenging discussions to ensure the patient is aware of all the options and is getting the most appropriate care for them.