Breast cancer treatment questioned

Associated Press

LONDON — The proportion of women with early-stage breast cancer receiving incorrect treatment in the United States has nearly doubled in the 1990s, increasing from 12 percent in 1989 to 22 percent by 1995, a new study says.

The reason is the growing popularity of lumpectomy, where doctors cut out only the cancerous part of the breast instead of removing the whole breast, and the failure of some doctors to carry out important follow-up treatments, said the study, published this week in The Lancet medical journal.

It estimated that about 22,000 American women each year may be receiving substandard care.

Two treatment options are considered appropriate when breast cancer has not spread to other areas. The first is a mastectomy — the removal of the breast — together with a dissection of the lymph nodes in the armpit to ensure they are cancer free.

The second is a lumpectomy, along with the lymph node check and radiation treatment of the area. Although it allows women to keep their breasts and can be as effective at eliminating cancer if done right, lumpectomy is a more complicated treatment than mastectomy.

The problem noted by researchers from the Medical College of Wisconsin in Milwaukee was that some doctors skipped the radiation or lymph node inspection, or both, when they performed lumpectomies.

In 1990, experts agreed at a National Institutes of Health consensus conference that lumpectomy is the preferable approach and set out the recommended procedures for both options. Since then, lumpectomy has been on the rise.

The researchers found that the proportion of women getting substandard lumpectomy treatment increased from 10 percent in 1989 to 19 percent at the end of 1995.

The study concluded that the problem is not that doctors are getting more lax when performing lumpectomies, but that more women overall were getting lumpectomies instead of mastectomies.

While about 15 percent of women got lumpectomies in 1983, about half were getting that treatment by 1995.