Rising Incidence of Tumorectomies without Breast Radiation in Patients Treated for Invasive Breast Cancer in Caribbean Nations
Background: Tumorectomy for invasive breast cancer (BC) is followed by local recurrence in 30% of patients who do not receive radiotherapy. In the United States 88% of tumorectomy patients receive radiation therapy. Many Caribbean nations lack radiation facilities and access to existing facilities is limited.
Methods: The charts of the 95 breast clinic patients treated in Caribbean nations for primary BC between 1980 and 2008 were reviewed. The nation of origin, original treatments, reported physician recommendations, and status at presentation to our clinic were recorded.
Results: Mastectomies (MCT) had been performed on 51 patients and tumorectomies (TCT) on 39. The ratio of TCT to MCT from 1980 to 1991 was 0.19, and then rose to 0.94, with a slight increase since. Only 6 of the 33 (18%) TCT patients had received radiation therapy. Patient accounts of why they had not been irradiated were available for 20 of 33: 12 denied referral for radiation, 4 refused it, and 4 had not been able to obtain it in their nation or region. At presentation to our clinic, 22 of the 51 MCT patients (43%) and 23 of the 33 TCT patients (70%) had locally recurrent BC.
Conclusions: TCT entails significant risk of local relapse in nations without, or with insufficient radiotherapy facilities for their populations.
* While 88% of tumorectomy patients in the United States also receive radiation therapy, many Caribbean nations lack the facilities to provide this same level of care.
* The disparity between radiation therapy in Caribbean nations compared to the United States was evident in the immigrant population receiving oncology care in a public hospital in Brooklyn, New York.
* Local recurrence was highly prevalent in the study population due to lack of radiation therapy in conjunction with tumorectomies and mastectomies performed in the country of origin.
* Hopefully, these results will encourage establishment of more radiotherapy facilities in the Caribbean. Meanwhile, physicians and patients there should critically evaluate the safety of breast conserving surgery.
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