SABCS: U.S. trends in treatment of primary BC

By Kim Irish, BCA Program Manager

Day 3: Friday, December 10

Dr. Todd M. Tuttle of the University of Minnesota presented fascinating data on recent United States trends in local treatment for breast cancer.  There is significant geographic and racial variation in mastectomy rates, for example – Connecticut has the lowest in the U.S., while Louisiana has the highest (Habermann et al. JCO 2010).  Unilateral mastectomy rates have been decreasing, while rates for contralateral prophylactic mastectomy (CPM), or a surgical procedure that removes the unaffected breast in women with disease in one breast, have increased in the last decade.  Some possible reasons for this include the increased testing for the BRCA genes, improved mastectomy and reconstruction techniques, increased use of breast MRIs, and potential overestimation of contralateral breast cancer risk.

Dr. Tuttle also discussed the use of radiotherapy (RT) after breast conserving surgery.  He stated that women who are less than 55 years old, women with high grade tumors, women with larger tumors, women with lymph node positive tumors, African American or Hispanic women, and women with ER-negative tumors are all associated with decreased used of RT after breast conserving surgery.  Some possible reasons for the omission of RT include the fact that RT must be done daily, some women do not have access to reliable transportation, an overestimation of side effects of RT, and “fumbled handoffs between physicians.”

I appreciated that Dr. Tuttle provided some recommended strategies for improving care for patients who choose surgery as a treatment for breast cancer.  He suggested that doctors need to do a better job of counseling their patients about true risk of recurrence; currently, he believes that breast cancer patients “grossly overestimate risk of recurrence.”  In addition, Dr. Tuttle recommended the use of patient navigators to help answer questions women may have about treatment options.  Both these strategies place  more responsibility on oncologists and their staff to ensure that women get all the information they need to make informed decisions.