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http://www.nytimes.com/2003/01/28/health/28TREA.html?tntemail0

Treatment: A Cancer Regimen Abandoned

By ERIC NAGOURNEY

octors treating breast cancer patients often fail to use chemotherapy as frequently as federal guidelines recommend, especially when patients are older, a study reports. The older the woman is, researchers found, the less likely she is to be given the treatment.

The study, in Annals of Internal Medicine, examines the use of chemotherapy in women who had tumors removed. The goal was to determine how closely doctors followed the recommendations of the National Institutes of Health. The lead author was Dr. Xianglin L. Du of the University of Texas Medical Branch at Galveston.

Although the researchers noted earlier studies suggesting the value of chemotherapy for many postsurgical breast cancer patients, they were careful to say that the findings did not necessarily mean that doctors were wrong to ignore the guidelines.

For one thing, they said, this kind of chemotherapy can be less effective in older patients. Doctors may also be concerned, perhaps unnecessarily, that the drugs may be too toxic for older patients, the study said. More research is needed, it says, to determine whether "the recommendations are overly aggressive or whether practicing oncologists are too conservative."

Still, the study found broad noncompliance with the guidelines, and an editors' note from the journal said "many unnecessary deaths could probably be prevented" if the recommendations were followed.

Health officials recommend chemotherapy when the cancer has spread to the lymph nodes and when the tumor is bigger than one centimeter, among other situations.

After studying the cases of more than 5,000 breast cancer patients in New Mexico, the researchers found that chemotherapy was given to 66 percent of women under 45, but to only 18 percent of women 60 to 64. Over all, 29 percent of the women received the treatment.
 

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