Many Women Need Radiation Even After a Mastectomy
Every week I see breast cancer patients decide on whether or not to have mastectomy, or whether to have lumpectomy and radiation. Many women tell me “I just want to have surgery and get it over with.” But for women whose breast cancer has spread to 4 or more lymph nodes in their axilla (armpit), a course of radiation treatment may be life-saving. Radiation treatments after mastectomy can reduce breast cancer recurrence by as much as 25%. And national guidelines explicitly recommend radiation for breast cancer patients with 4 or more positive axillary lymph nodes. There are a great many studies that suggest radiation after mastectomy may be indicated in women whose breast cancer spread to only one lymph node.
So How Many Women Get the Full Treatment That They Need?
The answer is that 1 in 3 breast cancer patients do not receive radiation recommended after mastectomy. And that’s really a big number in the United States. Dr. Quyen Chu, a professor of surgery at Louisiana State University Health Services Center, led a study of 56,990 women diagnosed with breast cancer in the National Cancer Database. Those women with breast cancer that spread to 4 or more lymph nodes were studied between 1998 and 2011. According to Dr. Chu’s study, only 65% woman underwent radiation therapy that was recommended. In a press release, Dr. Chu said “we could not tease out whether patients refuse treatment or there is a lack of awareness among women and physicians about the need for radiation therapy after mastectomy for locally advanced breast cancer.”
So Why Didn’t These Women Have Radiation?
I can only conclude it is because their surgeon did not schedule a consultation with a radiation oncologist before or after surgery. Upon more detailed analysis, 2 interesting facts emerged from this study. Firstly, those women who had chemotherapy or were re-admitted to the hospital within 30 days after surgery were more likely to undergo the recommended radiation. Secondly, whether or not women underwent radiation did NOT depend on insurance, education, race, ethnicity, income, education status, rural versus city locale, or size of the hospital.
To say these findings on nearly 57,000 breast cancer patients is disappointing is a real understatement. What was not reported in the study is whether or not women even saw a radiation specialist as part of their decision making process.
In this day and age, I believe that each and every breast cancer patient, whether or not they undergo lumpectomy or mastectomy, young or old, early-stage or advanced stage, needs to have a radiation oncologist as part of the “breast cancer conversation.”
Watch my interview on this subject to learn more. Living Dayton Interview on Breast Cancer