19 percent of breast cancer patients don't receive recommended radiation after mastectomy

Feb 3 2009

One-fifth of women who should receive radiation after a mastectomy are not getting this potentially lifesaving treatment, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.

The study looked at 396 women who were treated with a mastectomy for breast cancer. The researchers found that 19 percent of women who fell clearly within guidelines recommending radiation treatment after the mastectomy did not receive that treatment.

Results of the study appear online in the journal Cancer and will be published in the March 15 issue.

Post-mastectomy radiation is known to decrease the risk of cancer returning in the chest wall and has been shown to reduce mortality in high-risk patients, but there's been some debate within the cancer community about who is likely to benefit most. Current guidelines recommend radiation after mastectomy for women who had particularly large tumors or cancer in four or more of their nearby lymph nodes. Even women with fewer positive lymph nodes should strongly consider radiation treatment.

"There's an identifiable high-risk group for whom there's absolutely no debate -- they need radiation after their mastectomy. Even in this group for whom it's crystal clear, we found that only four-fifths were treated. That's not good enough. This is a potentially lifesaving treatment," says lead study author Reshma Jagsi, M.D., D.Phil., assistant professor of radiation oncology at the U-M Medical School.

The researchers found that the most common reason women cited for not considering radiation therapy was that their doctors did not recommend it.

"Much attention has been focused on educating people that they need radiation after lumpectomy. But many women assume having a mastectomy means radiation won't be needed. That's not always the case, and patients choosing one surgery over another hoping to avoid radiation need to be aware of this," Jagsi says.

She adds that doctor-patient communication needs to improve in this area and that more patients may benefit from a consultation with a radiation oncologist. Improving communications will be a goal of follow-up research from U-M's Cancer Surveillance and Outcomes Research Team, the researchers who conducted this study.