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Poor Understanding of Guidelines Results in Low National Use of Breast-Conserving Therapy

University of Pennsylvania Cancer Center
Last Modified: May 18, 1998

According to a report of the American College of Surgeons and the American College of Radiology, thousands of women every year could be spared mastectomies if national guidelines developed six years ago were properly followed. According to these guidelines, developed by the National Cancer Institute, approximately 75% of women diagnosed with early-stage breast cancer are eligible for breast-conserving therapy (BCT) -- lumpectomy followed by radiation therapy. These guidelines state that age, prognosis, and tumor type should not be used to choose mastectomy over breast-conserving therapy, and that the only factors that should be used to elect mastectomy are large tumor size, small breast size in comparison to tumor size, early pregnancy, and multiple tumors in various sites of the breast.

Unfortunately, this study of 17,931 women treated in 1994 found that only 44% of women with early stage breast cancer received the breast-sparing treatment. In addition, it found that surgeons were less likely to perform BCT on women over the age of 60, despite the guidelines and data which state that age should not be a factor in deciding to perform mastectomy over lumpectomy. Furthermore, the study found that only 78% of BCT patients received radiation therapy, contrary to the developed guidelines, largely due to failure to refer the patients for radiation. The researchers conclude that surgeons' misunderstanding of the national guidelines is a major factor responsible for low national rates of BCT.

[ Original Abstract ]