Study: Mastectomy More Likely If Hospital Lacks Onsite Radiotherapy Facility

Women who do not have ready access to a radiation therapy facility are more likely to undergo a mastectomy than a breast-conserving lumpectomy, according to a study reported in the April issue of the International Journal of Radiation Oncology, Biology and Physics.

Multiple trials have demonstrated that the overall survival rates of women who have lumpectomies plus radiation are equivalent to mastectomies in the treatment of breast cancer. Lumpectomies also provide better cosmetic results and preservation of a patient's body image. However, lumpectomy is used less frequently than mastectomy.

To examine the causes for this, researchers studied the influence of having an on-site radiation therapy facility at a community hospital in Durham, North Carolina. Before 1996, patients in Durham had to travel about five miles outside the city to Duke University Medical Center to receive radiation. In 1996, a radiation center was opened at the community hospital and staffed by the same Duke radiation oncologists.

Researchers compared lumpectomy rates before and after the opening of the radiation therapy facility in 586 patients. The lumpectomy rate at the community hospital was 29 percent prior to the opening of the on-site facility and 44 percent afterward. Researchers found that the lumpectomy rate increased at the community hospital even though radiation therapy had previously been available just five miles away at Duke.

According to study author Dr. Carol Hahn, of Duke University Medical Center, the increase may have been due to the reluctance of patients to travel to an unfamiliar medical center for radiation treatments or logistical barriers to patient care that may occur at a large medical center as Duke.

"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," said Hahn.

Other sources: American Society for Therapeutic Radiology and Oncology