Results from a recent study published in the journal JAMA Surgery showed that the percentage of patients with early-stage breast cancer undergoing breast-conserving therapy increased from 54.3 percent in 1998 to 60.1 percent in 2011, although nonclinical factors including socioeconomic demographics, insurance and the distance patients must travel to treatment facilities persist as key barriers to treatment.
Breast-conserving therapy (BCT) has been accepted by The National Institutes of Health (NIH) as a treatment modality for patients with early-stage breast cancer. However, many women continue to opt for a mastectomy.
To examine factors that influenced the surgical choices of women with early-stage breast cancer treated between 1998 and 2011, Isabelle Bedrosian, M.D., of the University of Texas MD Anderson Cancer Center, Houston, and colleagues used the National Cancer Data Base to evaluate the surgical options in 727,927 women with stage T1 or T2 breast cancer. Multivariate statistical analyses were used to evaluate the association between the likelihood of undergoing BCT and patient and facility variables.
The results showed that the use of BCT was greater in patients aged 52 to 61 years in comparision to younger patients and in those with the highest educational level. Rates of BCT were lower in patients without insurance relative to those with private insurance and those with the lowest median income.
Residence within 27.8 km of a treatment facility, academic cancer programs and United States Northeast location were all associated with higher rates of BCT when compared to residence farther from a treatment facility, community cancer programs and Southern location.
When researchers compared the use of BCT in 1998 versus 2011, they found increases across age groups, which were greater in patients age 52 to 61 (62.8 percent) compared with younger patients (57.8 percent), in facilities located in the South (45.1% in 1998 versus 55.3% in 2011), and in community cancer programs (48.4% in 1998 versus 58.8% in 2011).
“This comprehensive national review demonstrates that BCT rates have increased during the past two decades. Disparities in the use of BCT based on age, geographic location and type of cancer program have improved since 1998. However, insurance, income and travel distance to treatment facilities persist as key barriers to BCT use. These socioeconomic barriers are unlikely to be erased without health policy changes,” the study concludes.