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Many With High-Risk Breast Cancer Don't Undergo Radiation

Despite guidelines, number of women receiving postmastectomy radiation therapy not increasing

MONDAY, June 27 (HealthDay News) -- In response to the publication of clinical trials there was an increase in the number of women with high-risk breast cancer receiving postmastectomy radiation therapy (PMRT), but no further increase has been seen following publication of evidence-based guidelines, according to a study published online June 27 in Cancer.

Shervin M. Shirvani, M.D., from the University of Texas M.D. Anderson Cancer Center in Houston, and colleagues investigated the impact of recent clinical guidelines on PMRT use for breast cancer, based on the Surveillance, Epidemiology, and End Results-Medicare cohort data. A total of 38,322 breast cancer patients, 66 years of age or older, who underwent mastectomy between 1992 and 2005, were identified along with time trends in the receipt of PMRT for low-, intermediate-, and high-risk cases. Risk factors for PMRT omission were also identified.

The investigators found an initial increase in receipt of PMRT for high-risk patients from 36.5 to 57.7 percent between 1996 and 1998. However, no subsequent increase occurred despite the release of various guidelines advocating its use. Only 54.8 percent of high-risk patients received PMRT between 1999 and 2005. Within the high-risk group, the risk of PMRT omission was associated with smaller tumors or less advanced lymph node disease.

"After an initial increase in PMRT use in response to clinical trials, the use of PMRT did not increase further in response to guideline publication, and nearly 50 percent of patients with high-risk breast cancer still do not receive PMRT," the authors write.

The study was partially funded by Varian Medical Systems.

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