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Cancer Trends Progress Report – 2007 Update

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Breast Cancer Treatment
Colorectal Cancer Treatment


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Breast Cancer Treatment
Treatment

The proportion of women with node positive disease receiving appropriate treatment is high. Older women receive less treatment than younger women but there are not major differences in treatment among major racial and ethnic groups.

Note: Additional information on the trends in adjuvant chemotherapy and hormonal therapy will be available for early stage breast cancer in early 2009.

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Breast-Conserving Surgery and Radiation Treatment
Benefits of 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."

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Measure

Percent of women ages 20 and older, diagnosed with early-stage breast cancer (less than stage IIIA), receiving breast-conserving surgery and radiation treatment.

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Period – 1992–2002

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Trends – Rising between 1992 and 1998, falling slightly between 1998 and 2002

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Most Recent Estimates

In 2002, 41 percent of women ages 20 and older diagnosed with early-stage breast cancer (less than stage IIIA) received mastectomy, 37 percent received breast-conserving surgery plus radiation, and 19 percent received breast-conserving surgery only.

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Healthy People 2010 Targets

There are no Healthy People 2010 targets for cancer treatment including breast conserving surgery and radiation treatment.

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Multi-Agent Chemotherapy
Benefits of Treatment

For women with positive lymph nodes, multi-agent chemotherapy has been recommended by NIH since 1985, along with tamoxifen for those women with estrogen-receptor positive tumors, based on the results of numerous randomized controlled treatment trials.

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Measure

Percent of women ages 20 and older, diagnosed with node positive, stage I - IIIa breast cancer, receiving multi-agent chemotherapy.

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Period – 1987–2000

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Trends – Rising

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Most Recent Estimates

In 2000, 69 percent of women ages 20 and older, diagnosed with node positive breast cancer, received multi-agent chemotherapy.

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Healthy People 2010 Targets

There are no Healthy People 2010 targets for cancer treatment including multi-agent chemotherapy.

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Groups at High Risk for Not Receiving Appropriate Treatment

Studies have found that older women are less likely to receive radiation treatment in addition to breast-conserving surgery, after adjustment for the higher rate of pre-existing co-morbid conditions among older patients. Even elderly patients with no or very few co-morbid conditions, such as diabetes, kidney, or heart disease, were less likely to receive treatment. Similar decreases in the use of chemotherapy among older women also have been observed.

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Key Issues

Treatment options for breast cancer are complex, depending on nodal status, hormone receptor status, and age. Substantial toxicity and other risks are associated with radiation treatment and chemotherapy. As is the case for most cancers, women over the age of 70 have not been well represented in randomized controlled treatment trials. For all of these reasons, appropriate treatment should be the outcome of a fully informed, patient decision-making process that takes complex clinical factors and patient preferences into account. 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.

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Additional Information on Breast Cancer Treatment

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National Cancer InstituteDepartment of Health and Human ServicesNational Institutes of HealthUSA.gov