作者：Zosia Chustecka
出處：WebMD醫學新聞
September 9, 2008 — 來自麻州波士頓達那-法柏癌症研究治療中心的乳癌專家Eric Winer醫師指出，一項新研究結果顯示，乳癌患者腫塊切除後接受放射線治療有種族上的差異，且突顯了對所有乳癌患者應是標準照護但實際執行率卻很低的情況感到擔憂，除了年齡較大與病況較差的女性之外。
Winer醫師在華盛頓特區2008年乳癌座談會會前記者會中談到這個議題；該座談會由美國臨床腫瘤學會與其他幾個乳癌疾病學會贊助。
Winer醫師在對這項研究發現進行評論時強調，整體而言，接受放射線治療的比例是很低的；全美僅有74%白人女性與65%黑人女性在腫塊切除術後接受放射線治療；他指出，這是個很重要的發現，顯示許多女性仍然是被遺忘的。
他表示，在腫塊切除術後接受放射線治療仍有些許存活率上的好處，這兩種分歧的治療方式至少與腫塊切除術是一樣好的；但似乎某些女性僅接受兩個步驟中的其中一個，我對於看到放射線治療比例這麼低而感到驚訝；未接受放射線治療的那20%女性到底發生什麼事情了？她們消失到何處？我們必須找到她們。
這項顯示種族之間是有差異的研究結果，是由德州大學安德森癌症中心的Grace Smith醫師所發表，分析結果是來自一項收納超過37,000位醫療保險記錄的研究，這些病患在2003年因為初期、最近被診斷出來的乳癌而接受腫塊切除術；這些女性中，絕大多數（91%）是白人（37,305位女性中有34,024位）。
白人女性在腫塊切除術後接受放射線治療的比例比黑人女性高（整體而言為74%比上65%），且這樣的差異在研究者們將焦點放在70歲以下女性時同樣存在（81%比上71%）；在分析地域上的差異後，雖然某些區域的種族差異比其他區域高，但這樣的差別仍然存在。
Smith醫師評論，我們不清楚黑人女性接受放射線治療比例較低的原因，是否是因為沒有提供給她們、或是她們拒絕治療、還是因為她們無法完成整個療程的治療；我們必須確認並矯正造成這些差異的障礙，並努力強化乳癌病患於腫塊切除術後接受放射線治療所帶來之好處的認知。
【城鄉區域之間接受放射線治療比例並無差異】
會議中發表的另一項研究結果顯示，乳癌手術後接受放射線治療比例在城鄉區域之間並無差異；馬里蘭約翰霍普金斯大學的Lisa Jacobs醫師表示，這是一個令人驚奇的發現，我們認為放射線治療的可獲得性，會致使這些女性選擇腫塊切除術，而非更保守的外科手術但必須接受後續的放射線治療，然而，我們的研究結果並非如此。
Jacobs醫師與其同事針對將近80,000位病患的病歷進行分析，結果發現接受腫塊切除術的女性，在鄉村地區有81%、在城市地區有80%接受後續追蹤放射線治療；接受乳房切除術的女性中，鄉村地區有39%、城市地區有38%接受放射線治療。
研究者的結論是，顯然的，與醫學中心的地域距離，並不影響選擇乳房切除術還是腫塊切除術；如果一位居住在鄉村地區的病患需要接受放射線治療，看起來她們能夠接受這樣的治療。
研究者們表示無相關資金上的往來。
Racial Disparities in Radiation After Lumpectomy for Breast Cancer
By Zosia Chustecka
Medscape Medical News
September 9, 2008 — A new study showing racial disparities in radiation treatment for breast cancer after a lumpectomy also reveals "worryingly low rates overall for what should be a standard of care in all but the oldest and sickest women," said breast cancer expert Eric Winer, MD, from the Dana Farber Cancer Institute, in Boston, Massachusetts.
He was speaking at a presscast ahead of the 2008 Breast Cancer Symposium in Washington, DC. The meeting was sponsored by the American Society of Clinical Oncology and several other cancer and breast disease societies.
Commenting on results, Dr. Winer highlighted the fact that the radiation rates were low overall. Nationwide across the United States, only 74% of white women and 65% of black women received radiation after lumpectomy. "This is a really important finding," he said; t shows that there are many women still falling through the cracks."
"There is a small survival advantage across the board [with] radiation after lumpectomy," he said, with results for this 2-pronged approach at least as good as for those for mastectomy. But it seems that some women undergo only 1 of the 2 steps in this approach. "I am shocked to see such low rates for radiation," he said. "What is happening to the 20% of women who do not have radiation? Where are they disappearing to? We must find them."
The results showing racial disparity were presented at the meeting by Grace Smith, MD, PhD, MPH, from the MD Anderson Cancer Center, in Houston, Texas. The finding comes from an analysis of more than 37,000 Medicare records of women who were treated in 2003 for early-stage, newly diagnosed breast cancer with a lumpectomy. The majority (91%) of these women were white (34,024 of 37,305 women).
More white women than black women received radiation after the lumpectomy (74% vs 65% overall), and this disparity persisted when the researchers focused on women who were younger than 70 years of age (81% vs 71%). The disparity also persisted when the data were analyzed by geographic region, although some areas had much higher racial disparities than others.
"We don't know if fewer black women are receiving radiation therapy because it is not offered to them, because they decline treatment, or because they are unable to complete a whole course of treatment," Dr. Smith commented. "We need to identify and correct the obstacles that are causing these disparities," she said, "and work to increase the awareness about the benefits of radiation therapy following lumpectomy among breast cancer patients."
No Difference in Radiation Between Rural and Urban Areas
Another presentation at the same meeting showed that radiation rates after breast cancer surgery do not differ between rural and urban areas. "This was a surprising finding," said Lisa Jacobs, MD, from Johns Hopkins University, in Baltimore, Maryland. "We thought that access to radiation was driving rural women to choose mastectomy over more conservative surgery with follow-up radiation, but our findings show this is not the case."
Dr. Jacobs and colleagues examined nearly 80,000 patient records, and found that among women who had a lumpectomy, 81% in urban areas and 80% in rural areas had follow-up radiation. Among the women who underwent mastectomy, 39% in urban areas and 38% in rural areas received radiation.
It appears that geographic distance from centers that offer radiation is not a factor that is influencing the decision of whether to opt for a mastectomy or a lumpectomy, the researchers concluded. "If a patient in a rural area needs radiation, it seems that they can get to it."
The researchers have disclosed no relevant financial relationships.
2008 Breast Cancer Symposium: Abstracts 91 and 238.
[ 本帖最後由 goodcat1111 於 2008-9-19 20:49 編輯 ] |
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