Saving the Breast in Cancer Surgery

Breast conservation surgery for early-stage breast cancer became more common

(RxWiki News) As bad as a breast cancer diagnosis is, the prospect of breast cancer surgery may be nearly as scary for some women. Many women, however, are taking advantage of newer surgery options that save as much of the breast as possible.

From 1998 to 2011, rising numbers of women with early-stage breast cancer chose to have breast conservation surgery, a new study found.

However, barriers to treatment — such as distance to travel and socioeconomic status — may still prevent some women from making this choice, according to the authors of this study.

“This comprehensive national review demonstrates that BCT [breast conservation therapy] rates have increased during the past two decades," the study authors wrote. "Disparities in the use of BCT based on age, geographic location and type of cancer program have improved since 1998. However, insurance, income and travel distance to treatment facilities persist as key barriers to BCT use. These socioeconomic barriers are unlikely to be erased without health policy changes."

Isabelle Bedrosian, MD, of the University of Texas MD Anderson Cancer Center, and colleagues wanted to see whether and how breast conservation rates had changed between 1998 and 2011. Dr. Bedrosian and team felt that many factors could affect a woman’s choice of treatment and wanted to explore that topic.

When a woman has breast cancer, she most often has three major treatment options: radiation, chemotherapy and surgery. Many women need a combination or all three.

Prior to 1990, a mastectomy — removal of the entire breast — was the standard of care for many breast cancers. In 1990, however, the National Institutes of Health issued a statement that backed a less extensive surgery.

In breast conservation surgery, only the tumor and some of the surrounding tissue are removed. After surgery, most women need radiation to ensure that all of the cancer is eliminated, according to the American Cancer Society.

Dr. Bedrosian and colleagues used data from the National Cancer Data Base for a group of more than 727,000 women. Breast conservation surgery rates rose from 54.3 percent in 1998 to 60.1 percent in 2011.

Women who were older — ages 52 to 61 — were more likely to opt for breast conservation surgery than younger women, Dr. Bedrosian and team found. Women with more education were also more likely to choose breast conservation. Women who had access to academic cancer programs and were somewhat close to a treatment center were also more likely to choose breast conservation.

Women who did not have insurance and those with low incomes were less likely to choose breast conservation.

Margaret Sacco, MD, a general surgeon affiliated with Overlook Medical Center and Morristown Medical Center told dailyRx, "As surgeons we are often the first physician to discuss treatment options with women and we always need to be cognizant of not only the tumor biology but also the patient’s social, psychological and lifestyle needs. These all help to determine the best treatment plan for each individual patient, as for some breast conservation may not meet their personal needs."

Dr. Sacco continued, "What this study does not adequately address as the data goes only to 2011 is the rise in mastectomy and prophylactic mastectomy in the last decade. This has been well documented in the literature and many institutions find this is related to the increased use and availability of genetic testing, use of MRI for detecting multi-centric disease and improved plastic surgical reconstruction options. My experience is the number of young women choosing mastectomy and prophylactic mastectomy has recently risen due to the fears of recurrence and without the data to support increased survival from prophylactic mastectomy."

In an editorial about this study, Lisa A. Newman, MD, of the University of Michigan in Ann Arbor, wrote, “It is an unfortunate reality that unequal access to care persists as a significant cause of health outcome disparities ... Patients who lack daily transportation access, patients who cannot coordinate radiation treatments with job and/or child care responsibilities, and patients who live remote from a radiation facility face often insurmountable barriers to pursuing breast-conserving surgery, even if they have a disease pattern that is ideally suited for this treatment.”

The study and editorial were published June 17 in JAMA Surgery.

A grant to the MD Anderson Cancer Center funded this research. Dr. Bedrosian and team disclosed no conflicts of interest.

Review Date: 
June 16, 2015