Nearly half of older women with advanced stage breast cancer who undergo a mastectomy don't receive radiation therapy, despite guidelines that say it can save lives, according to a report released Monday in the journal Cancer.
Researchers from MD Anderson Cancer Center in Houston looked at data for more than 38,000 women age 66 and older who underwent a mastectomy after a breast cancer diagnosis between 1999 and 2005. Nearly 8,000 of whom had an advanced form of the disease.
Although major guidelines released during the six-year period recommended radiation therapy after mastectomy for women with advanced forms of the disease, nearly half of the women whose records the researchers analyzed during that period did not receive the therapy.
Some women may have opted out of radiation therapy, said Dr. Benjamin Smith, assistant professor of radiation oncology at MD Anderson Cancer Center, and co-author of the study.
The women who were less likely to receive radiation were over age 80, suggesting that some of the women may have favored quality of life over duration of life.
But more likely, Smith said, the results suggest a disconnect between knowing what recommended guidelines state and following them.
"Historically, radiation therapy was not thought to be helpful after mastectomy," said Smith. "So this bias against radiation after a mastectomy still probably exists to a certain extent."
Previous research found that women were more likely to receive radiation after a mastectomy if their surgeon recommended it. But, according to ABC News' chief health and medical editor Dr. Richard Besser, treatment, even beyond breast cancer treatment, is subjective for each patient.
"Difference in care doesn't mean that any one patient is getting suboptimal care," said Besser. But, he said, it is important for patients to understand what treatment is best for them. Besser suggested bringing someone along to an appointment to make sure the treatment options are understood.
Besser also suggested the following checklist of questions that may help patients make more-informed choices about their care:
What is my condition called?
What are my treatment choices, and what are the pros and cons of each one?
What treatment do you recommend for me and why?
Do you have written information about my condition that I can read? Can you recommend a good website or support group?
Can I follow up with you by phone if I have any additional questions?
Where can I go for another opinion?
Get a printable version of this checklist to bring along to your next doctor's visit.
While many patients may hesitate to ask their doctor to direct them somewhere else for a second opinion, many doctors are happy to do it, he said. And asking these types of questions could help patients understand what's best for them and to feel better informed about their medical care.
"I think more people are more apt to get a second quote for their car insurance than get extra quotes for medical care," said Besser. "Asking the right questions could mean the difference between right and better care."