Changing Treatment of Breast Cancer in New Mexico From 1969 Through 1985

Abstract

A review of information from the New Mexico Tumor Registry on women diagnosed as having primary breast cancer from 1969 through 1985 revealed temporal changes in the surgical treatment of this disease. After 1980 the percentage of women receiving breast-conserving surgery for local-stage disease increased from 6% to 25%. Most surgeons performing operations for breast cancer had not performed a breast-conserving operation before 1981 but had used this procedure at least once in the period from 1981 through 1985. Women younger than 50 years or older than 80 years were most likely to undergo this procedure. In that period, radiotherapy after breast-conserving surgery could not be documented for 26% of the women 65 years old or younger or for 56% of the women aged 65 years or older. Thus, there has been a marked shift in New Mexico in the surgical approach to local-stage breast cancer in the 1980s. This shift involved most surgeons treating the disease and included women of all age groups. The apparent lack of adjuvant radiotherapy in some women receiving conservative surgeries may prove to be a deleterious consequence of this change in surgical management.

Effect of Nurse Case Management on the Treatment of Older Women with Breast Cancer

“…13 Although such a complex approach might easily be performed in the context of a comprehensive cancer center, it is important to understand that general surgeons treat many older women with breast cancer in community hospitals without radiation facilities or specific cancer programs. 12,14 It is perhaps not surprising, then, that several investigators have documented large gaps between ''best practice'' and the actual treatment received by older women in the community. [1][2][3]6,11,12,[14][15][16][17][18][19][20][21][22][23][24] There have been concerns that breast conserving surgery has been underused.…”

“…[1][2][3]6,11,12,[14][15][16][17][18][19][20][21][22][23][24] There have been concerns that breast conserving surgery has been underused. 6,11,18,22,25 In addition, older women who choose breast-conserving surgery are at increased risk for receiving this operation without adjuvant irradiation 1,3,6,14,15,17,18,20,22,24 or axillary dissection. 16,17,19,23,24 Community-living older women with breast cancer are also less likely to receive referrals to an oncologist, 15 chemotherapy, 15,22 and tamoxifen.…”

“…The reasons for this may be related more to matters of access to healthcare resources than to medical management decisions per se. 6,26 In particular, it has been shown that women with advanced age, 2,11,14,15,18 minority ethnicity, 7,8,11 low income, 9,11 cognitive impairment, 3 or at risk for poor social support 3,9,11 are most likely to receive inadequate care after a breast cancer diagnosis. Thus, attempts to improve the care given to older women with breast cancer must address the matters of access to and coordination of resources.…”

Sentinel-Node-Driven Personalized Radiation Techniques Ranging from Partial Breast Irradiation to Regional Nodal Radiation after Breast-Conserving Surgery

“…Although the Oxford meta-analysis demonstrated not only a significant reduction of local recurrence but also an overall survival benefit with adjuvant breast radiation therapy after BCS [3,4], 15% -30% of patients who undergo BCS refuse WBI [5][6][7][8][9][10]. The latter may be caused by potential factors, including severe and long-term adverse events, such as rib fracture, lung injury, and late cardiovascular toxicity, and by long-term daily visits to radiation institutions for at least 5 -6 weeks.…”

Intraoperative Open-Cavity Implant for Accelerated Partial Breast Irradiation Using High-Dose Rate Multicatheter Brachytherapy in Japanese Breast Cancer Patients: A Single-Institution Registry Study

“…On the basis of these data, breast-conserving surgery followed by WBI has become the accepted standard of treatment. However, irradiation of the entire breast on a daily basis for 4 -6 weeks is time consuming for the radiation center, and 15% -30% of patients who undergo lumpectomy do not receive WBI because of physician bias, patient age, fear of radiation treatment, distance from a radiation treatment facility, or socioeconomic factors [6][7][8][9][10][11]. Moreover, radiation-induced lung injury and late cardiovascular toxicity are further concerns regarding WBI.…”