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    Many Breast Cancer Patients Skip Radiation

    Study Shows Many Don't Get Recommended Radiation Therapy After a Mastectomy

    Underuse of Radiation Therapy continued...

    Smith's study did not go into why the women didn't have the recommended treatment. "Some may be elderly and frail," he says. Some may have other illnesses and declined the option.

    Because the researchers only studied women who were Medicare-eligible and over 65, the findings may not apply to younger women, he says.

    Radiation is generally well-tolerated, Smith says. Among the downsides, he says, is a risk of lymphedema, an accumulation of lymph fluid in the arm that can be uncomfortable. Fatigue is common.

    The study was partially funded by Varian Medical Systems. It makes devices for treating patients with radiation and other therapies.

    Radiation's Benefits

    The findings are surprising, says Janice Kim, MD, assistant professor of radiation oncology at the University of Washington, the Fred Hutchinson Cancer Research Center, and the Seattle Cancer Care Alliance. She reviewed the findings.

    She is especially surprised that the number is not higher than the 54%, as that represents the high-risk group. "The high-risk group is a little bit more black and white," she says. "There is a definite benefit. There is a survival benefit."

    Her advice for women with advanced breast cancer: "Have a very thorough discussion with your radiation oncologist. If you have access, try to go to a multidisciplinary cancer center -- one with surgeons, medical oncologists, radiation oncologists."

    Seth A. Rosenthal, MD, vice chair of the American College of Radiology's Radiation Oncology Commission, is not surprised by the findings. Even though the data show benefits, he suspects ''a lot of patients aren't being referred." People may not be fully aware of the benefits, says Rosenthal, a radiation oncologist in Sacramento, Calif.

    His advice? "If you have positive nodes at the time of your mastectomy, you should ask the question if you would benefit from post-mastectomy radiation therapy."

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