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31 March 2003
Location Influences Choice Of Mastectomy Or Lumpectomy 
Women with breast cancer are less likely to conserve their breasts if there is no radiation therapy facility located nearby, according to the April 2003 issue of the International Journal of Radiation Oncology, Biology and Physics, the official journal of ASTRO, the American Society for Therapeutic Radiology and Oncology. Multiple trials have demonstrated that lumpectomy plus radiation, also known as breast conserving therapy, provides overall survival rates equivalent to mastectomy in the treatment of breast cancer. Breast conserving therapy provides excellent cosmetic results and better preservation of a patient's body image, and therefore it is the National Cancer Institute's recommended standard of care for patients who are candidates for the procedure. More than 75 percent of breast tumors can be effectively treated with breast conserving therapy. Given the excellent cosmetic and survival outcomes achieved with breast conserving therapy, one would expect it to be used more frequently than mastectomy. However, breast conserving therapy is used less frequently than mastectomy. To examine the causes for this, researchers assessed the influence of having an on-site radiation therapy facility at a community hospital in Durham, N.C. Before 1996, patients in Durham had to travel to Duke University Medical Center, located five miles from the community hospital, to receive radiation. In 1996, a center was opened at the community hospital and staffed by the same Duke radiation oncologists. Researchers compared rates of breast conserving therapy before and after the opening of the radiation therapy facility. A total of 586 patients were evaluated. The rate of breast conserving therapy at the community hospital was 29 percent prior to the opening of the on-site facility, and 44 percent after. Researchers found that rates of breast conserving therapy increased at the community hospital even though radiation therapy had previously been available just five miles away at Duke. "The increase in breast conserving therapy may have been due to several factors," said Carol A. Hahn, M.D., of Duke University Medical Center and lead author of the study. "Patients may have been reluctant to choose breast conserving therapy because it would have meant traveling to an unfamiliar medical center for radiation treatments. They may also have been less inclined to go to Duke for radiation treatments because of the logistical barriers to patient care that may occur at such a large medical center. Community physicians should be aware that logistical difficulties may impact a patient's selection of her breast cancer therapy, and work toward minimizing the impact of such logistical difficulties. This study also illustrates that the need for a particular service at a community hospital should be evaluated with the thought that the demand for that service may increase if it is more readily available."
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