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Guideline Adherence & Post-Mastectomy Radiation Use

Radiation therapy after mastectomy is not always necessary for women with low-risk breast cancer, but it is frequently recommended for high-risk breast cancers. For intermediate breast cancers, use of radiation therapy after surgery remains controversial. Following the publication of three landmark trials in the mid- 1990s showing that post-mastectomy radiation therapy decreases locoregional recurrence and improves survival in patients with high-risk breast cancer, rates of this type of radiation increased from 36.5% to 57.7% from 1996 to 1998 (Table 1). In the late 1990s, several major associations released treatment guidelines endorsing the use of post-mastectomy radiation therapy in this population, most notably the American Society of Clinical Oncology and the National Comprehensive Cancer Care Network. A New Analysis of Post-Mastectomy Radiation In the October 15, 2011 issue of Cancer, investigators sought to determine if the use of post-mastectomy radiation has increased since national guidelines have recommended this approach for high-risk breast cancer patients. Researchers analyzed data from the SEER-Medicare database on 38,332 women aged 66 or older who underwent mastectomy for invasive breast cancer between 1992 and 2005. “Our study found that about 55% of women with high-risk breast cancer were receiving post-mastectomy radiation therapy,” says Benjamin D. Smith, MD, lead author of the analysis. “That is substantially lower than what we had anticipated.” “About 55% of women with high-risk breast cancer were receiving post-mastectomy radiation therapy. That is substantially lower than what we had anticipated.” Dr. Smith says that the rate of radiation therapy when indicated following lumpectomy is about 90%. “It’s paradoxical,” he adds. “Although radiation after lumpectomy has been shown to lower risk of cancer recurrence...

Cancer in the Future: Looking Into the Crystal Ball

Considering that cancer occurs more commonly in older adults, the aging of America is expected to increase the number of cancer diagnoses substantially. The expected increase in minorities may impact cancer care, particularly since certain minority groups have higher cancer incidence rates and lower disease-specific survival rates than non-minorities. “Compounding the problem is that minorities and older adults can be particularly vulnerable to suboptimal cancer care,” explains Benjamin D. Smith, MD. “Both groups have been under-represented in cancer clinical trials and are also subject to disparities in cancer treatment. Quantifying the likely trajectory of the number of cancer cases in older and minority patients can help clinicians define the expected societal burden of cancer and guide research and health policy priorities.”  Compelling New Data  In the April 29, 2009 Journal of Clinical Oncology, Dr. Smith and colleagues conducted a study designed to project the anticipated number of cancer cases through 2030. Data collected on all cancer sites demonstrated that the total expected cancer incidence in the United States will increase by an additional 45% over the next 20 years, rising from about 1.6 million cases in 2010 to 2.3 million in 2030 (Figure 2). “Between 2010 and 2030, a 67% increase in cancer incidence is anticipated for patients aged 65 and older as compared with only an 11% increase in cancer incidence anticipated for patients younger than 65,” Dr. Smith notes. “Overall, the percent of all cancers diagnosed in older adults is expected to increase from 61% to 70% in the next 20 years.”  According to site-specific data in the study, the leading cancer sites in men in 2030...
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