Xianglin L. Du, MD, PhD, lead investigator of the study and assistant professor of internal medicine and geriatrics at the University of Texas Medical Branch at Galveston, explained that a NIH consensus conference in 1990 determined that physicians should recommend chemotherapy after surgery for pre- and post-menopausal women with early-stage breast cancer that has spread to the lymph nodes or who have a tumor larger than 1 centimeter with negative hormone receptor status.
The study describes the patterns of adjuvant chemotherapy in 5,101 women aged 20 or older with operable breast cancer, identified by the New Mexico Tumor Registry between 1991 and 1997. Overall, 29 percent of women received chemotherapy. Sixty-six percent of women aged 45 and younger received chemotherapy, versus 44 percent of women between the ages of 50 and 54, 31 percent of women between the ages of 55 and 59, and 18 percent of women between the ages of 60 and 64. Among women aged 65 to 69 and those over 75, only 12 percent and 3 percent, respectively, received chemotherapy.
"What we found striking was that the use of adjuvant chemotherapy decreased substantially with the ages of the women in the study, even when that therapy was recommended according to the current NIH guidelines," said Du. "In other words, there is a clear divergence between NIH recommendations and clinical practice.
"The question of whether the recommendations are overly aggressive versus whether practicing oncologists are too conservative in chemotherapy use should be addressed in future outcome studies," Du said.
Annals of Internal Medicine, the world's most widely cited and peer-reviewed specialty journal, is published twice monthly by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) in Philadelphia. ACP-ASIM, with more than 115,000 members, is the second-largest medical association in the United States. ACP-ASIM members are internists: specialists in the prevention, detection, and treatment of illnesses that primarily affect adults.
NOTES TO EDITOR:
Embargoed copies of the article, "Discrepancy between Consensus Recommendations and Actual Community Use of Adjuvant Chemotherapy in Women with Breast Cancer," (p. 90) can be obtained by calling the ACP-ASIM Communications Department at 1-800-523-1546, ext. 2656.
To talk with Xianglin L. Du, MD, PhD, call Jennifer Reynolds-Sanchez at the University of Texas Medical Branch at Galveston 409-742-0794; jareynol@utmb.edu.
The adjuvant chemotherapy study is highlighted in the Internal Medicine Report video news release (VNR) series produced by the American College of Physicians-American Society of Internal Medicine. The VNR will be released on Monday, Jan. 20, 2003. Downlink times and coordinates:
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Annals of Internal Medicine