Caring Currents

Breast Cancer Alert: Follow-Up Care Is a Life or Death Issue

Last updated: Dec 03, 2008

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Lately I've been hearing lots of stories from friends and acquaintances whose moms, wives, and sisters have had breast tumors removed but who are resisting or hesitating about having additional treatment right away. In fact, some have felt such anxiety and concern about radiation or chemo they've waited a long time, debating whether to have treatment at all.

Now, a new study suggests that such waiting is even more common than I would have guessed. Researchers at Weill Cornell Medical College analyzed data from the National Cancer Institute's cancer registry and found that one in five women over 65 delayed or didn't have their follow-up radiation treatment after having a breast lump removed.

And such waiting proved risky indeed: Those with Stage I cancer -- which typically should present almost no risk of recurrence -- who delayed radiation for 12 weeks or longer were four times as likely to have a recurrence or subsequent new primary tumor compared with those who had their radiation soon after surgery. Even those who waited just eight weeks were 1.4 times more likely see their cancer recur or to have new tumors turn up.

Why the hesitation and resistance to treatment? Sometimes it's due to scheduling problems and issues with coordination of care: It may take a long time to get the needed referrals and insurance clearances. This was the issue cited by the researchers who did the study. Another reason I've heard a lot about is miscommunication or misinformation from doctors, who may overemphasize that cancer grows more slowly in older people.

While this is true, it's only one factor to take into account. With women living longer, this would be primarily a consideration for a woman who was over 75 or whose cancer showed evidence of being slow-growing --  for example, a tumor that had been present for some time. Radiation treatment does require considerable coordination, particularly in regard to scheduling and transportation. A typical treatment schedule is five days a week, Monday to Friday, over a course of five to seven weeks.

The study also found that women who underwent a "truncated" treatment schedule, having radiation for three weeks or less, increased the risk of recurrence by 32 percent. If someone you know has had breast surgery and is debating what to do next, it's well worth getting involved. Encourage her to discuss her concerns with her doctor and, if appropriate, help coordinate a care team to get her to and from appointments and handle other tasks.

Image by Flickr user cj smithson used under the Creative Commons Attribution License.