Original Article

Rising Incidence of Tumorectomies without Breast Radiation in Patients Treated for Invasive Breast Cancer in Caribbean Nations

Authors: Gurinder S. Sidhu, MD, Deborah Bristol, Nithya Palanisamy, MD, Theophilus Lewis, MD, Jeremy Weedon, PhD, Nilesh Patel, MD, Barbara Adamson, RN, Albert S. Braverman, MD

Abstract

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.


Key Points


* 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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References

1. Robles SC, Galanis E. Breast cancer in Latin America and the Caribbean. Rev Panam Salud Publica 2002;11:178–185.
 
2. Greene FL, Page DL, Fleming ID, et al (eds). American Joint Committee on Cancer Stage Manuel. Philadelphia, PA, Springer, 2002.
3. Montague ED, Gutierrez AE, Barker JL, et al. Conservation surgery and irradiation for the treatment of favorable breast cancer. Cancer 1979;43:1058–1061.
4. van Dongen JA. Breast conserving therapy in operable breast cancer; a review. Eur J Cancer Clin Oncol 1983;12:1741–1747.
5. Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985;312:665–673.
6. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. Early Breast Cancer Trialists Collaborative Group. N Engl J Med 1995;333:1444–1455.
7. Fisher B, Anderson S, Bryant J, et al. Twenty-five year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233–1241.
8. Nattinger AB, Hoffmann RG, Kneusel RT, et al. Relation between appropriateness of primary therapy for early-stage breast carcinoma and increased use of breast-conserving surgery. Lancet 2000;356:1148–1153.
9. Clarke M, Collins R, Darby S, et al; Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet 2005;366:2087–2106.
10. Cazap EL, Buzaid A, Chacon R, et al. Breast cancer care in Latin America and the Caribbean. Proc Am Soc Clin Oncol 2007;25:21140.
11. Freedman RA, He Y, Winer EP, et al. Trends in racial and age disparities in definitive local therapy of early stage breast cancer. J Clin Oncol 2009;27:713–719.