Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for T(is,1,2) breast cancer

BACKGROUND

We hypothesized that wide-field brachytherapy (BRT) after margin negative excision would result in complication rates, local recurrence rates, and cosmesis scores equivalent to external beam radiotherapy (ERT).

METHODS

Patients with T(is,1,2) tumors less than or equal to 4 cm, 0 to 3 positive axillary nodes, and negative inked surgical margins were entered prospectively into BRT phase I/II trial. Patients who met the eligibility criteria for BRT but were treated with ERT during the same time period were retrospectively identified as controls. A blinded panel of healthcare professionals graded cosmetic outcome.

RESULTS

Fifty patients with 51 breast cancers received BRT from January 1992 to October 1993. We identified 94 patients eligible for BRT but concurrently treated with ERT. At a median follow-up of 75 months, the two groups were similar for grade III treatment toxicities, local/regional recurrence rates, and cosmesis scores.

CONCLUSIONS

For selected breast cancer patients undergoing breast-conserving therapy, BRT is an attractive alternative to ERT.

Enhancing cancer control: assessing cancer knowledge, attitudes, and beliefs in disadvantaged communities

Four hundred and two residents of a lower socioeconomic, African-American community were surveyed to determine their knowledge, attitudes, and beliefs regarding cancer and cancer screening. The results from those surveyed were compared to those from 290 members of the Ochsner Health Plan. This group was predominantly white and of higher socioeconomic status. Both groups were health conscious and expressed a willingness to participate in cancer screening. There were significant differences noted in general cancer knowledge between the two groups. A number of etiologic myths about cancer were still prevalent in the African-American community. Overall, participants in the African-American community had a more fatalistic view of cancer and were less trusting of the medical community. Cancer screening rates were similar for cervical and colorectal cancer but were significantly higher for breast and prostate cancers. The results of the survey identify a number of barriers to cancer screening among this African-American community and support the need for a culturally sensitive, community-based cancer education program.

Cancer Knowledge, Attitudes and Beliefs among African Americans

Four hundred two residents of a disadvantaged African American community in New Orleans were surveyed to determine their knowledge, attitudes, and beliefs regarding cancer and cancer screening. The residents were interviewed in their homes by trained community members. Two hundred ninety members of the Ochsner Health Plan (OHP) were also surveyed and the results from both groups were compared. Both groups were health conscious and expressed a willingness to participate in cancer screening. Mean cancer knowledge scores were lower in the target population (4.95) when compared with the OHP group (5.84). Thirty-two percent of the target population could identify the 7 cancer warning signs versus 47% of the OHP group. Similar percentages of women in both groups could identify risk factors for breast cancer, but a number of etiologic myths were prevalent in the African American community. Participants in the African American community had a more fatalistic view of cancer and were less trusting of the medical community. Cancer screening rates were similar for cervical and colorectal cancer, but a significantly higher percentage of women in the OHP group received regular mammograms, 83% versus 43% in the target population. Thirty-two percent of the target population and 75% of the OHP group stated they had received a digital rectal examination. Only 34% of the African American males had received a Prostate Specific Antigen test versus 46% in the OHP group. The results of the survey identify a number of barriers to cancer screening among the African American community and support the need for a culturally sensitive, community-based cancer education program.

Cancer incidence and mortality among African Americans

In the future, the largest proportional increase in the population will be among minority groups. To date, there are a number of studies which document the disparities in cancer incidence and survival existing between white Americans and minorities, especially African Americans. African Americans have the highest cancer incidence and mortality rates in the United States. Much of this difference can be directly related to socioeconomic status. There are also cultural differences which result in differing attitudes towards health care. In the future, interventions designed to encourage cancer prevention and screening behaviors must seek to overcome the barriers to access in a culturally sensitive fashion.