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Saving the Breast From Cancer: Only for the Rich?

WebMD Health News

May 11, 2000 (Washington) -- Poor, less-educated women with breast cancer are more likely to lose a breast to the disease than are their more affluent counterparts, a new study shows. Wealthy, college-educated women are more likely to undergo a procedure called lumpectomy.

A lumpectomy is when only the tumor is removed, leaving the breast essentially intact, and the patient then undergoes radiation or chemotherapy treatments afterward. The cancer has to meet certain criteria (such as small size) to be eligible for this treatment. Mastectomy is removal of all the breast tissue and sometimes the muscle underlying the area.

To discover "what factors influence a woman's choice to undergo lumpectomy or mastectomy," lead researcher Lisa F. Baron, MD, and colleagues at The Medical University of South Carolina in Charleston surveyed almost 680 breast cancer survivors who'd been treated at North Carolina and South Carolina centers between 1995 and 1998. She presented the results of the study at a medical conference here this week.

The women answered questions about their age, income, marital status, and education level at the time of diagnosis, their family history, whether they'd ever been pregnant, how their cancer was detected, and where they'd received their treatment information. "We asked if they talked to their friends or clergymen, who they confided in, and what treatment their physician had recommended," says Baron.

Of the 406 women who responded, almost 350 had undergone mastectomy and 58 had undergone lumpectomy. Those patients were matched up for age at the time of diagnosis, marital status, family breast cancer history, and prior pregnancy.

Of all the variables, says Baron, "what made a difference was patient education and income." Compared to women who'd had a mastectomy, those who'd undergone lumpectomy were wealthier, were more likely to be college graduates, and tended to be married at the time of diagnosis.

According to Baron, there are a number of possible explanations. Lower-income, less-educated women may not have easy access to transportation or affordable child care, or have the job flexibility necessary to allow the six weeks of daily, tiring chemotherapy treatments that go along with the lumpectomy procedure. Mastectomy, on the other hand, is quicker and does not require additional resources.

What's more, she says, these women may not know that under certain circumstances, "lumpectomy does not lessen the odds of long-term survival." In this study, when women were given a choice of treatment, 31% decided on mastectomy, and 33% opted for lumpectomy, "although breast conservation is often better in the long term for the patient's feelings about herself as a woman," says Baron. "These women need to know ... that choosing lumpectomy will not affect their life expectancy."

Whether the disparity is a matter of transportation and other logistical details, insufficient information, or a combination, Baron tells WebMD that education is key. "We need to pay very special attention when it comes to teaching low-income and less-educated women about the benefits of breast conservation treatment," she says.

The fact that everyone who participated in this study is a survivor "should empower women to take charge of their health," says Baron. In addition to doing monthly self exams and getting regular mammograms, she says, "if you've been diagnosed with breast cancer and you're scared, if things like transportation or child care or job concerns are keeping you from getting treatment -- you need to communicate that to your health care provider."

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