Older breast cancer patients not getting radiation

Access to care cited as one factor

By By Sabriya Rice CNN

(CNN) - Of women age 65 and older who undergo a mastectomy to treat advanced breast cancer, nearly half may not be receiving the optimal treatment, a new study finds. The oversight puts these women at greater risk of having the cancer return and increases their risk of dying from the disease.

The new study, published in the journal Cancer, finds that 45.2 percent of older women found to have high-risk breast cancer between 1999 and 2005 did not receive additional post-mastectomy radiation treatment, despite the publication of major guidelines recommending the therapy.

High risk patients included those in whom Stage 3 breast cancers were diagnosed, patients with tumors 5 centimeters or larger and those where the tumor had spread to four or more lymph nodes.

Recommendations posted on the governments National Guidelines Clearinghouse say there is clear evidence that giving radiation therapy to high risk patients after mastectomy not only reduces recurrence, but also improves survival rates.

According to the American Cancer Society, the risk of developing breast cancer increases as you age, with about two out of every three invasive breast cancers found in women age 55 or older.

So why aren't older patients getting radiation?

"When 45 percent are not getting the treatment, it suggests that we're giving less than the best available care for a significant number of women," says Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society.

The study authors say there seems to be a critical disconnect between practice and theory, which prevents these women from getting the optimal care. "Our observations demonstrate the failure of evidence-based guidelines to satisfy their intended goal of summarizing and disseminating clinical evidence to everyday practice," the study authors write.

"It has to do with access to care," explains Dr. Ben Smith, the study's lead author. The study did not look specifically into why they women did not get care, however the authors did note a surprising trend.

"Our study found that women who live in areas with a lot of radiation oncologists were 20 percent more likely to get radiation than women who did not," he explains. He adds that getting daily radiation treatment for five to six weeks can be a particular challenge for older patients, especially those living in rural areas with limited access to transportation.

A recent report, Aging in Place: Stuck Without Options, found that by 2015, more than 15.5 million Americans ages 65 and older will live in communities where public transportation service is poor or non-existent, which can make getting to doctor appointments problematic for this age group.

Lichtenfeld agrees public transportation is a "major issue," but also notes another possibility -- that many older patients believe the mastectomy is all they need. "They think they don't need to go through the many weeks of radiation therapy," Lichtenfeld explains. If given the option between undergoing chemotherapy, which can save the breast, or mastectomy, where the breast is removed, many women in their 60s will choose the latter.

The problem is they may not be having the "what if" discussion, talking to their doctor about the possibility of recurrence. It's up to the patient and their doctors to have these challenging discussions to ensure the patient is aware of all the options and is getting the most appropriate care for them.

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