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Breast-conserving Surgery and Radiation Treatment Clinical trials have demonstrated that women with early-stage breast cancer who receive breast-conserving surgery with radiation have survival similar to women who receive a mastectomy. A 1990 NIH Consensus Development Panel concluded that "breast conservation treatment (BCS followed by radiation therapy) is an appropriate method of primary therapy for the majority of women with stage I and II breast cancer and is preferable because it provides survival equivalent to total mastectomy and axillary dissection while preserving the breast." Percentage of women age 20 and older, diagnosed with early-stage breast cancer (less than stage IIIA), receiving breast-conserving surgery and radiation treatment. Trends – Rising between 1992 and 1998, falling between 2004 and 2008. Download: data (Excel) | image (JPEG) In 2008, 37 percent of women age 20 and older diagnosed with early-stage breast cancer (less than stage IIIA) received a mastectomy, 41 percent received breast-conserving surgery plus radiation, and 19 percent received breast-conserving surgery only. There are no Healthy People targets for cancer treatment, including breast cancer treatment. Multi-agent Chemotherapy For women with positive lymph nodes, multi-agent chemotherapy has been recommended by NIH since 1985. However, the NIH Consensus Conference on Breast Cancer in 2000 stated insufficient numbers of women age 70 or older were included in clinical trials to make a recommendation about chemotherapy. Based on the results of numerous randomized, controlled treatment trials, tamoxifen has been recommended for women with estrogen-receptor positive breast cancer. Percentage of women age 20 and older, diagnosed with node positive, stage I–IIIa breast cancer, receiving multi-agent chemotherapy. Trends – Rising use through 1995 but stable after that time. Download: data (Excel) | image (JPEG) In 2005, 67 percent of women age 20 and older diagnosed with node positive breast cancer received multi-agent chemotherapy. A breast cancer NCI patterns of care study is currently being conducted for diagnosis year 2010. There are no Healthy People targets for cancer treatment, including breast cancer treatment, and multi-agent chemotherapy. Groups at High Risk for Not Receiving Appropriate Treatment Studies have found that older women are less likely to receive radiation treatment following breast-conserving surgery. Even elderly patients with no or very few co-morbid conditions—such as diabetes, kidney, or heart disease—were less likely to receive treatment. Although there are no clear guidelines for the use of chemotherapy in women age 70 or older, the use of chemotherapy is lower among older women. Emerging treatments for breast cancer include the anti-HER2/neu antibody, trastuzumab for patients with HER2 over expressing cancers, and aromatase inhibitors either in conjunction with or instead of tamoxifen. The inclusion of women age 70 or older in clinical trials is necessary to determine the benefit of more aggressive therapies. Additional Information on Breast Cancer Treatment
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