BREAST-SURGERY USAGE VARIES

                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: MONDAY, January 27, 1992                   TAG: 9201270140
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-2   EDITION: METRO 
SOURCE: Associated Press
DATELINE: NEW YORK                                LENGTH: Medium
BREAST-SURGERY USAGE VARIES
A breast-cancer patient's chance of having surgery that spares the breast varies around the country, perhaps partly because of differences in availability of follow-up radiation treatment, a study suggests.
New England had the highest rate of such surgery, and parts of the southeastern and north-central regions the lowest, researchers said.
The numbers may fail to show the true size of regional differences because of the study's limitations, said a co-author, Dr. David Winchester. He suspects differences have narrowed since 1988, the year analyzed in the study.
In New England, 40.2 percent of patients in the study had a breast-sparing partial mastectomy. The lowest rates were 11.5 percent for the region that includes Alabama, Kentucky, Mississippi and Tennessee, and 13.6 percent in the area that includes the Dakotas, Iowa, Kansas, Minnesota, Missouri and Nebraska. The figure is 21 percent for the region that includes Virginia, the Carolinas, Delaware, the District of Columbia, Florida, Georgia, Maryland and West Virginia.
The national average was 25.5 percent.
Reasons for the variations are unknown, said Winchester, medical director of the cancer department at the American College of Surgeons.
But differences in availability of follow-up radiation treatment may play a role, and "in some instances, regional differences might indicate a need for increased professional and public education," Winchester and his co-authors wrote in presenting the analysis in the current issue of the journal Ca.
The study used hospital data on 41,680 breast-cancer patients, about 31 percent of the nation's breast-cancer patients treated in 1988. About 10 percent of the sampled patients had no surgery.
Rather than removing the breast, breast-conserving surgery takes out just the tumor and some surrounding normal tissue, and samples the lymph nodes in some cases. The surgery is followed by radiation therapy for five to six weeks.
Research in the 1980s found the approach as effective as removing the breast in some cases, "but I think the utilization of this procedure is lower than it should be," Winchester said in an interview last week.
Dr. Dan Kenady of the University of Kentucky Medical Center in Lexington said rural geography may have contributed to his region's low rate of breast-sparing surgery.
Patients may drive five hours to reach his center, Kenady said. Many women may decide against breast conservation because of the prospect of making such a trip five days a week for up to six weeks for follow-up radiation, he said.
Some rural women could stay in town during the treatment period, but "a lot of them have difficulty because to them Lexington is a big city," he said. "It's too big and too crowded, too much traffic."
Beyond the geographic problem, "there's no question there are surgeons out there that basically are not offering the options," Kenady said.
The distance to radiation therapy also discourages some women in Michigan, said Dr. Janet Osuch, associate professor of surgery at Michigan State University and an American Cancer Society spokeswoman on breast cancer.
"The fact is, breast preservation therapy is not available to everyone in the U.S.," she said. "It's available to women in cities."

by Archana Subramaniam by CNB