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LSU Health Shreveport surgeon finds deviation in breast cancer care in national study

Kate Archer Kent

Breast cancer patients who undergo a mastectomy should receive radiation treatment if the cancer has spread to four or more nearby lymph nodes. That’s standard care. But only 65 percent of women get post-mastectomy radiation therapy, according to a new study released Tuesday by the American College of Surgeons.

Dr. Quyen Chu, a surgery professor at LSU Health Shreveport, analyzed almost 57,000 cases of locally advanced breast cancer occurring between 1998 and 2011, housed in the National Cancer Data Base.

“We don’t know the cause. We don’t know whether women choose not to do it or we don’t know whether physicians are recommending it or not. We just know that there’s a high rate of noncompliance for recommended treatment that has been in existence since 2000,” Chu said, who interpreted the data with colleagues at LSU Health Shreveport with funding from a university professorship.

Since 2000, the leading cancer think tanks have recommended radiation – along with chemotherapy – for most breast cancer patients. But there is lag time for any recommended treatment guidelines to become standard practice, according to Dr. Daniel McKellar, chair of the American College of Surgeons Commission on Cancer.

When McKellar reviewed mastectomy cases in the same cancer database for 2012 – the most recent data on hand-- almost 86 percent of women received radiation. He says the Commission on Cancer would like to see 90 percent compliance.

“We’ll actually be following this each year, as we do with our other quality measures, and looking at the improvement. As we see improvement, we may raise the threshold for compliance,” McKellar said.

Chu found that a patient’s socioeconomic status, income level, and many other variables did not influence treatment protocol. But he found women were five times more likely to get radiation after a mastectomy if they also received chemotherapy.

“I hope the study will empower women to start asking their physicians, hey, I had a mastectomy. I had four or more positive lymph nodes. Do you think I need radiation? I think many women will accept that they will need chemotherapy, hormonal therapy or biologics, but they might not ask if they need radiation,” Chu said.

Chu presented his findings in December at the Southern Surgical Association’s annual meeting. The study will be published in the Journal of the American College of Surgeons later this year.

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