Use of Lumpectomy Among Early-Breast Cancer Patients on the Rise

Despite the increased use of breast-conserving therapy among women with early-stage breast cancer, many women continue to undergo mastectomy, according to a study from researchers at the University of Texas MD Anderson Cancer Center in Houston published in JAMA Surgery.

The researchers used the National Cancer Data Base to examine surgical choices of women with stage T1 or T2 breast cancer who were treated between 1998 and 2011. The use of breast-conserving therapy increased during that time period (from 54.3% to 60.1%), but there are still socioeconomic factors that remain key barriers to breast-conserving therapy. Rates were lower among patients without insurance and in the lowest median income compared with those with private insurance.

“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,” principal investigator Isabelle Bedrosian, MD, FACS, associate professor in the Department of Surgical Oncology at the University of Texas MD Anderson Cancer Center in Houston, and medical director of the Nellie B. Connelly Breast Center at MD Anderson, said in a statement. “But despite significant progress by the medical community, there are significant pockets of women where this therapy is underutilized.”

Breast-conserving therapy was more common in older patients and among women with higher education levels. Other factors associated with higher rates of breast-conserving therapy were academic cancer programs, living in the Northeast, and living less than 17 miles from a treatment facility.

Distance from treatment facilities may only be a factor insomuch as it attributes to the patients’ ability or willingness to travel for daily radiation therapy, which is a standard follow-up to lumpectomy. In the South, women often have greater distances to travel to treatment facilities compared with patients in the Northeast, Dr Bedrosian surmised.

She added that income and insurance status play a significant role as women from low-income families may not be able to take off the time needed for radiotherapy post-lumpectomy.

While the findings that breast-conserving therapy rates have increased over the past decade were encouraging, according to Dr Bedrosian, the data also highlights the need for considering socioeconomic factors to address disparate use of the therapy across demographic groups.

“The socioeconomic barriers are unlikely to be erased without health policy changes,” Dr Bedrosian said.