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Saving the Breast From Cancer: Only for the Rich?

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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.

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