Rising incidence of tumorectomies without breast radiation in patients treated for invasive breast cancer in Caribbean nations.
BACKGROUND
Tumorectomy for invasive breast cancer (BC) is followed by local recurrence in 30% of patients who do not receive radiotherapy. In the United States 88% of tumorectomy patients receive radiation therapy. Many Caribbean nations lack radiation facilities and access to existing facilities is limited.


METHODS
The charts of the 95 breast clinic patients treated in Caribbean nations for primary BC between 1980 and 2008 were reviewed. The nation of origin, original treatments, reported physician recommendations, and status at presentation to our clinic were recorded.


RESULTS
Mastectomies (MCT) had been performed on 51 patients and tumorectomies (TCT) on 39. The ratio of TCT to MCT from 1980 to 1991 was 0.19, and then rose to 0.94, with a slight increase since. Only 6 of the 33 (18%) TCT patients had received radiation therapy. Patient accounts of why they had not been irradiated were available for 20 of 33: 12 denied referral for radiation, 4 refused it, and 4 had not been able to obtain it in their nation or region. At presentation to our clinic, 22 of the 51 MCT patients (43%) and 23 of the 33 TCT patients (70%) had locally recurrent BC.


CONCLUSIONS
TCT entails significant risk of local relapse in nations without, or with insufficient radiotherapy facilities for their populations.
Division of Hematology-Oncology, Department of Medicine, Downstate Medical College, State University of New York, Brooklyn, NY 11203, USA.
Gurinder S
GS
Sidhu
Deborah
D
Bristol
Nithya
N
Palanisamy
Theophilus
T
Lewis
Jeremy
J
Weedon
Nilesh
N
Patel
Barbara
B
Adamson
Albert S
AS
Braverman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D017691:Caribbean Region / Q000453:epidemiology; D003906:Developing Countries; D054242:Emigrants and Immigrants; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009518:New York; D011247:Pregnancy; D015995:Prevalence; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D055815:Young Adult