Challenges to Optimal Local Therapy in Breast Cancer

William J. Gradishar, MD reviewing Lautner M et al. JAMA Surg 2015 Jun 17. Newman LA. JAMA Surg 2015 Jun 17.

Obstacles to breast-conserving therapy include age, socioeconomic factors, and proximity to treatment centers.

Breast-conserving therapy (BCT) that combines lumpectomy and breast irradiation has been the preferred treatment for most women with early-stage breast cancer (EBC) since multiple randomized trials have shown equivalent survival with BCT compared with mastectomy. To examine recent trends in the use of BCT, investigators accessed the National Cancer Data Base to study more than 700,000 women treated for early-stage breast cancer between 1998 and 2011.

The use of BCT increased from 54.3% to 60.1% overall during this period. However, there were persistent and disturbing differences based on age, socioeconomic factors, and proximity to treatment centers. The use of BCT was greater in patients aged 52 to 61 years (62.8%) compared with younger patients (57.8%) and in women with more education (61.7%). Rates of BCT were lower in patients without insurance (49.3%) compared with those with private insurance (62.3%) and with the lowest median income (51.1%). BCT was more commonly used in the Northeast than in the South, at academic centers, and in close proximity to treatment centers.

Citation(s):

Lautner M et al. Disparities in the use of breast-conserving therapy among patients with early-stage breast cancer. JAMA Surg 2015 Jun 17; [e-pub].

Newman LA.Ongoing consequences of disparities in breast cancer surgery. JAMA Surg 2015 Jun 17; [e-pub].