Senior Women Risk More Breast Cancers, Death if
Radiation Therapy Delayed
One in 5 older women with early breast cancer
experience delayed or incomplete radiation treatment
Dec. 2, 2008 - A new analysis of the National
Cancer Institute's cancer registry has found that as many as one in five
older women – senior citizens age 65 or older - experience delayed or
incomplete radiation treatment following breast-conserving surgery, and
that this suboptimal care can lead to additional cancer and increased
risk of death.
Dr. Heather Taffet Gold of Weill Cornell Medical
College and colleagues found that among a nationally representative
sample of nearly 8,000 breast cancer registry patients aged 65 and
older, almost 1,300 women experienced delayed radiotherapy and
approximately 270 had incomplete radiotherapy.
Of these women, those with Stage 1 breast cancer
had worse health outcomes associated with this less-than-ideal therapy,
while those with a precancerous lesion called ductal carcinoma in situ (DCIS)
were not as affected.
"Timeliness of post-surgical radiotherapy is
important in reducing the risk of subsequent recurrence or new breast
malignancies in patients with early breast cancer. Delaying treatment by
eight weeks or more significantly increased the odds for recurrence,"
says Dr. Gold, the study's lead author and an assistant professor of
public health in the Division of Health Policy in the Department of
Public Health at Weill Cornell Medical College.
"One possible reason for the delays is that the
coordination of care can be a challenge as treatment is usually
delivered by multiple providers from different specialties, including
surgeons, radiation oncologists and medical oncologists."
Stage 1 breast cancer patients with radiation
treatment delayed by eight weeks were 1.4 times more likely to have a
recurrence or subsequent new primary breast tumor compared with those
receiving timely treatment; they also had reduced survival.
Patients whose radiotherapy was delayed by 12 weeks
or longer were four times more likely to have a recurrence or subsequent
new breast tumor.
And women who had incomplete radiation treatment
for Stage 1 breast cancer - those who underwent fewer than three weeks
of the typical five-to-seven-week regimen - had a higher rate of overall
mortality, with a 32 percent higher likelihood of death.
The researchers also found treatment disparities in
subgroups of older women. "Older black women were more likely to delay
radiation treatment, whereas women living in areas with a high
concentration of radiation oncologists were less likely to delay.
Additionally, older women living in high-poverty areas were less likely
to complete radiation treatment," says Dr. Gold.
The work appears in the latest online issue of the
journal Cancer and the Dec. 1, 2008, print issue. Research collaborators
include Huong T. Do, M.A., and Andrew W. Dick, Ph.D., senior economist
at the RAND Corporation in Pittsburgh, Pa.
The study is based on an evaluation of women aged
65 and older diagnosed with either DCIS or Stage 1 breast cancer from
1991 to 1999 and followed through 2002 in registries of the
Surveillance, Epidemiology, and End Results (SEER) Program sponsored by
the National Cancer Institute.
This nationally representative, population-based
study of older women provided a unique opportunity to study the effects
of suboptimal treatment in the community setting.
"Our findings indicate that radiation treatment
should be made easier for all patients to ensure completion and that
delays should be minimized. To improve health outcomes following
treatment for breast cancer, health care facilities and providers should
implement supportive services, such as transportation, and provide
educational materials to encourage and ease access to optimal radiation
treatment, thereby improving disease-free and overall survival," said
Dr. Andrew Dick, senior author on the study.
The study was supported by a Mentored Research
Scholar Grant awarded to Dr. Gold by the American Cancer Society.
About Weill Cornell Medical College
Weill Cornell Medical College, Cornell University's
medical school located in New York City, is committed to excellence in
research, teaching, patient care and the advancement of the art and
science of medicine, locally, nationally and globally. Weill Cornell,
which is a principal academic affiliate of NewYork-Presbyterian
Hospital, offers an innovative curriculum that integrates the teaching
of basic and clinical sciences, problem-based learning, office-based
preceptorships, and primary care and doctoring courses. For more
information, visit
www.med.cornell.edu.
Keep up with the latest news for senior citizens, baby
boomers
Dec. 2, 2008 - A new analysis of the National
Cancer Institute's cancer registry has found that as many as one in five
older women – senior citizens age 65 or older - experience delayed or
incomplete radiation treatment following breast-conserving surgery, and
that this suboptimal care can lead to additional cancer and increased
risk of death.