Uptick in Breast-Conserving Therapy, But Disparities Still Exist

Utilization of breast-conserving therapy (BCT)-the recommended approach for women diagnosed with early-stage breast cancer-has increased by 6% from 1998 to 2011. Still, there are barriers to this optimal form of early breast cancer therapy, including socioeconomic factors, according to the results of a study published in JAMA Surgery.

BCT was more prevalent among women age 52 to 61 years (62.8%) compared with women younger than 52 years (57.8%) (odds ratio of 1.14). Women with higher levels of education were also more likely to undergo BCT. Additionally, women treated in academic cancer programs and in the Northeast region of the United States, as well as those living less than 17 miles from a treatment facility, were more likely to receive BCT compared with those treated at community centers, those living in the Southern United States, and those living more than 17 miles from a treatment facility. Lower income and lack of insurance were also barriers.

Meeghan Lautner, MD, of the department of surgical oncology at the University of Texas MD Anderson Cancer Center in Houston, and study coauthors used data from the National Cancer Data Base to analyze the therapy and surgery choices of 727,927 women with T1 or T2 breast cancer.

However, BCT did increase from 1998 to 2011 in community cancer centers (from 48.4% in 1998 to 58.8% in 2011) and in treatment centers in the South (45.1% in 1998 to 55.3% in 2011).

Breast-conserving surgery such as lumpectomy followed by radiation therapy requires a significant time commitment, including daily radiation therapy for 6 weeks. “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 suitable for this treatment,” wrote Lisa A. Newman, MD, MPH, director of the Breast Care Center at the University of Michigan in Ann Arbor, in an accompanying editorial.

Newman highlighted practice-changing results from the American College of Surgeons Oncology Group Z0011 trial published in 2011 that demonstrated similar outcomes with sentinel lymph node dissection and the more invasive axillary lymph node dissection. The trial, noted Newman, has allowed patients to forego the lifelong morbidity of lymphedema and arm and shoulder dysfunction associated with the removal of all lymph nodes. But, the patients with socioeconomic disadvantages highlighted in the current study are unlikely to benefit from the results of the Z0011 trial, according to Newman.

For their part, Lautner and colleagues said that the disparities in patient age, geographic location, and cancer program noted in their study are unlikely to change without the implementation of new or updated healthcare policies.