Scientists discover wide variations in breast cancer treatment
An international study of breast cancer treatment, published in the British Journal of Surgery, has found that treatment varies widely from country to country in spite of an international consensus on best practice. The five-year, nine-country study was carried out by researchers from Europe, Japan and the US, and involved nearly 10,000 women with early breast cancer in Belgium, France, Germany, Greece, Ireland, Japan, the Netherlands, the UK and the US. 'The primary aim of our research study was to carry out an international, randomised trial to evaluate the efficacy and safety of the breast cancer drug exemestane, alone or following tamoxifen,' explained co-author Professor C. J. H. van de Velde from Leiden University Medical Center (LUMC) in the Netherlands. 'However, because we had recruited a large number of patients, we decided that this also provided us with an invaluable opportunity to examine how different countries treat postmenopausal women with early breast cancer. 'The results of our study show wide international variations in the percentage of women who receive breast-conserving surgery (BCS) rather than breast removal (mastectomy) and radiotherapy after surgery,' said Professor van de Velde. Nearly 58% of the women who took part in the study had T1 breast tumours (less than 2cm), 37% had T2 tumours and 5% had larger or more advanced T3 and T4 tumours. The highest percentage of node-negative disease (where the cancer does not affect the lymph nodes) occurred in the countries with the highest rates of T1 tumours (Germany, France and the US). Women with T1 tumours were most likely to receive BCS, but statistics for this treatment varied widely. Although rates of T1 tumours were similar in France and the US, 89% of women with T1 tumours were treated with BCS in France compared to only 55% in the US. Lymph nodes were affected by the disease in around 47% of the women and around 82% of these patients overall underwent an axillary lymph-node dissection operation. However, figures ranged from 75% of patients in the US to 99% in Ireland and the UK. Mastectomy and radiotherapy rates also varied greatly. In general, women with T1 tumours were more likely to receive a mastectomy than to have BCS, but in France 42% of T1 patients underwent mastectomy compared to 69% in the US. The overall mastectomy rate for all breast tumour types was 44%; the lowest rates were in France (19%) and the highest in Greece (56%). Despite international guidelines that radiotherapy should be part of BCS, the only countries that had 100% treatment rates were Belgium and France. The highest rates of non-treatment for radiotherapy were in Ireland, Japan, the UK and the US. Around 39% of women received radiotherapy after a mastectomy and 93% after BCS. 'Our study showed that despite international consensus guidelines, there are wide global variations in the way postmenopausal women are treated for early breast cancer,' said Professor van de Velde. 'We believe that there should be further efforts to ensure that women can all benefit from the most effective breast cancer treatment available, regardless of which country they live in.'
Countries
Belgium, Germany, Greece, France, Ireland, Japan, Netherlands, United Kingdom, United States