What About Post-Mastectomy Radiotherapy?

These pages consist of a series of e-mail messages that I sent to the Breast-Cancer List in November and December 1996, slightly updated since.  I am not a doctor, but a concerned lay person who reads carefully in original medical literature as best as I can.        

Radiotherapy is used after almost all lumpectomies for breast cancer. It is used less often after mastectomies.  Why?        

    1. In some situations it is simply not appropriate under any current approaches.         

    2. In other situations it may be appropriate but it is not recommended.

Fully informed doctors may themselves disagree with one another on how they would treat a given case.  That is inevitable, but the patient should know something about the other viewpoints or choices.  Sometimes the responsible doctor may take clues from a patient about her (or his) preferences, and may shape his or her recommendations in accordance with those clues.  That shaping, if it occurs, seems to me more problematical.  Finally, some busy doctors may simply not be aware of the latest research literature on this topic.  That is understandable, but it does suggest the importance of being familiar oneself with the research.        

 
  1. Post-Mastectomy Radiotherapy (Intro) 
  2. Theories on the Natural History of Breast Cancer 
  3. Post-Mast. Radiotherapy for N(+): Arriagada (Nov. 95) 
  4. Books & Post-Mast Radiotherapy 
  5. Radiation: Oxford Overview 
  6. Radiation 2: Cuzick & Heart-sparing Techniques 
  7. Radiotherapy 3: Stockholm Study, Others 
  8. Radiotherapy 4: Pierce and Lichter Overview 
  9. Radiotherapy 5: Rutqvist 1996 Overview
  10. Radiotherapy 6: Other Studies, Old & New
 A breast cancer patient must herself make the decisions on each potential treatment. Sometimes the process can include bringing studies to the attention of good doctors who are simply unaware of them. In other situations, the doctors are quite aware of the studies, but do not have sufficient time to educate their patients fully about the studies, and they must search on their own.  Perhaps these pages will help stimulate some discussions.        

Because some people have asked for these messages I wrote last year, I decided the easiest solution to making them available would be to make them available on the World Wide Web. I will try to make some hyper links in the messages to materials referenced, but for the most part it will be necessary to go to a hospital's medical library to get copies of the studies referenced here.        

A final note: I have not updated this research since December 1996, except for some additional Medline research into abstracts. It is advisable to search for more recent information after reviewing the materials here.        

John Bonine, Professor of Law, University of Oregon