Lumpectomy surgery and radiation were always meant to go together. But for some pretty inexcusable reasons, they don't always.

When a woman has lumpectomy surgery (removal of the cancerous lump with a margin of healthy tissue around it, while saving the rest of the breast), the procedure should be followed by radiation to the breast. Why? To help neutralize and destroy any mutated cells that might remain and grow into breast cancer later. Without these life-saving doses of radiation, about 40 percent of women who had lumpectomy will, within two years, have a recurrence of breast cancer at the site where it started. So the need for radiation in this case is obvious.

Yet according to a recent study, only about 75 percent of women having lumpectomy surgery for breast cancer get radiation afterwards! Why? The reasons are disturbing.

The study revealed a pattern. The 25 percent of lumpectomy patients not receiving radiation and, specifically, those who were not advised by their breast surgeon that they should be getting radiation, were primarily older, black women and women who were unmarried. Those living outside urban areas were also less likely to receive radiation, even if they needed it.

Another pattern exposed by the study: Surgeons who were female and had an M.D. degree were more likely than male M.D.s or health care professionals to refer their patients for radiation therapy after lumpectomy surgery.

The accepted standard of care for treatment of breast cancer is to do radiation after lumpectomy, so that there are only a few special circumstances in which radiation may not be recommended following lumpectomy surgery. Here are several:

• A woman who lives far from a radiation facility and, due to this distance, isn't able to come in for this adjuvant therapy every day for 5 or 6 weeks. The surgeon will instead usually recommend a mastectomy with some form of reconstruction. Mastectomy surgery, unless the patient has locally advanced disease, usually doesn't require radiation afterwards; thus, from a survival perspective, mastectomy is equal to lumpectomy plus radiation.
  
• A very elderly woman who has many other serious medical problems such as congestive heart failure or COPD, and whose doctors believe does not have much longer to live, would probably not be offered radiation after lumpectomy. In such circumstances, she may lose her life to other natural causes long before a possible recurrence of her breast cancer would take her.

If you are embarking on lumpectomy surgery for treatment of breast cancer, be extremely aware that you are signing up for radiation, too: they go hand in hand. It is not in your best interest to try to negotiate out of doing it.