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Lumpectomy Rates Up, but Barriers Still Exist

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Many studies done in the 1970s showed that lumpectomy plus radiation to treat women diagnosed with early-stage breast cancer offered the same survival rates as mastectomy. Based on these studies, the U.S. National Institutes of Health released a statement in 1990 saying that lumpectomy plus radiation was preferred over mastectomy to treat early-stage breast cancer.

Lumpectomy is sometimes called breast-conserving surgery or breast-conserving therapy.

Still, some women who’ve been diagnosed with early-stage breast cancer choose to have mastectomy.

According to statistics from 2014, about 60% of women diagnosed with early-stage breast cancer choose lumpectomy followed by radiation. Researchers wanted to know why women chose one surgery over the other.

A study suggests that a number of factors, including access to radiation therapy after lumpectomy, affect the type of surgery a woman chooses for early-stage breast cancer.

The research was published online on June 17, 2015 by the journal JAMA Surgery. Read the abstract of “Disparities in the Use of Breast-Conserving Therapy Among Patients With Early-Stage Breast Cancer.”

In the study, researchers from the University of Texas MD Anderson Cancer Center looked at the records of 727,927 women diagnosed with early-stage breast cancer between 1998 and 2011. The records were in the National Cancer Data Base, which is sponsored by the American Cancer Society and the American College of Surgeons. The National Cancer Data Base includes about 70% of all newly diagnosed cancer cases in the United States.

Overall, rates of lumpectomy to treat early-stage disease went up from 1998 to 2011: from 48.4% to 58.8%.

The researchers found several factors made it more likely that a woman would have lumpectomy:

  • being age 52 or older
  • having a higher educational level
  • living near a university hospital/treatment center
  • living in the Northeast United States
  • living within 17 miles (27.8 kilometers) of a treatment center

Other factors made it less likely that a woman would have lumpectomy:

  • being younger than 52
  • not having insurance
  • having a low income
  • living in the Southern United States
  • living farther than 17 miles from a treatment facility

“Looking at the big picture, strides have been made to reduce disparities in the use of this very effective treatment for women with early-stage breast cancer,” said Isabelle Bedrosian, M.D., F.A.C.S., associate professor of surgical oncology and medical director of the Nellie B. Connelly Breast Center at MD Anderson and lead author of the study. “But despite significant progress by the medical community, there are significant pockets of women where this therapy is underutilized. The socioeconomic barriers are unlikely to be erased without health policy changes.”

She added that lower rates of lumpectomy among women who live farthest from treatment centers may be because the women aren’t able to travel for daily radiation therapy, the standard follow-up to lumpectomy. This also may account for lower rates of lumpectomy in the South, where women often have longer travel distances to treatment centers. A woman’s income and insurance status also play a role in the type of surgery chosen, she said. For example, a woman from a low-income family may not be able to take the time off she needs for weeks of radiotherapy.

“These data also demonstrate the breadth of the socioeconomic factors that need to be considered to adequately address the disparate use of [lumpectomy] across demographic groups,” Dr. Bedrosian concluded.

If you’ve been diagnosed with early-stage breast cancer, you and your doctor will talk about a surgical approach that makes the most sense for you and your unique situation. You will take into account a number of factors, including:

  • your preferences
  • any other health problems you have
  • ALL the characteristics of the cancer
  • how close you are to treatment facilities

Whichever surgery you choose -- lumpectomy plus radiation or mastectomy with or without radiation -- know that much research has shown that both are equally effective in removing early-stage breast cancer and reducing the risk of it coming back.

For more information on factors to consider when deciding on a type of surgery for early-stage breast cancer, visit the Mastectomy vs. Lumpectomy page.

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