Obese breast cancer patients undertreated - study

WASHINGTON, Jan 19 (Reuters) Breast cancer patients who are either obese or poorly educated are twice as likely to get lower-than-optimal doses of chemotherapy, US researchers reported.

The finding, published in the Journal of Clinical Oncology, may help explain why some women relapse and others do not, despite the availability of good treatments for the disease.

The problem appears to be with doctors who mean well and want to avoid causing side-effects in their patients, the team at the University of Rochester Medical Center in New York found.

''Simply put, this evidence shows that doctors are likely to reduce the chemotherapy levels for these women, even though there is no solid medical basis to do it,'' yesterday said Dr Gary Lyman, who led the study.

They looked at the records of 764 women treated for breast cancer between 2002 and 2005 at 115 randomly selected, private oncology practices around the country.

They found that 21 per cent of obese women received less than 85 per cent of the standard dose for their weight. But just 10 per cent of lean women were undertreated.

More than 32 per cent of women who did not graduate from high school got lower-than-recommended doses, compared with 14 per cent of high school or college-educated women.

''We have new therapies and cures out there for many forms of cancer and sadly, sometimes we're not curing people because they are not getting the full doses that should be standard,'' Lyman said in a statement.

A second study in the same journal found women who carefully chose their own breast cancer surgeon tended to get more experienced surgeons and care at specialized centers, compared to women referred by another doctor or their health plan.

The team at the University of Michigan Comprehensive Cancer Center examined the cases of 1,844 women recently diagnosed with breast cancer in Detroit and Los Angeles.

More than 60 per cent of the patients said they were referred to their surgeon by another doctor, and 15 per cent were referred by their health plans. About 25 per cent chose their surgeon based on reputation.

Women with more education and higher incomes were more likely to have chosen their own surgeon.

Evidence shows that patients who choose any type of doctor based on their experience tend to do better. For surgery, patients recover better if they choose a hospital or clinic where the operation is performed frequently.

''Women with breast cancer should be aware that referrals from another doctor or their health plan may not connect them with the most experienced surgeons or the most comprehensive practice settings in their community,'' said Dr Steven Katz, who led the Michigan study.

''Patients might consider seeking a second opinion, especially if they are advised to undergo a particular treatment without a full discussion of the options.'' Reuters SSC VP0940