Omission of radiation therapy after breast‐conserving surgery in the United States

Abstract

BACKGROUND: Radiation therapy (RT) after breast-conserving surgery (BCS) is associated with a significant reduction in ipsilateral breast tumor recurrence and breast cancer mortality rates in patients with early stage breast cancer. The authors of this report sought to determine which patients with breast cancer do not receive RT after BCS in the United States. METHODS: The Surveillance, Epidemiology, and End Results registry was used to determine the rates of RT after BCS for women with stage I through III breast cancer in the United States from 1992 through 2007. A multivariate analysis was performed to identify independent predictors of omission of RT. RESULTS: In total, 294,254 patients with invasive, nonmetastatic breast cancer were identified who underwent surgery from 1992 through 2007. Most patients (57%) underwent BCS; among those, 21.1% did not receive RT after BCS. The omission of RT increased significantly from 1992 (15.5%) to 2007 (25%). The receipt of RT also decreased significantly for patients with increased cancer stage, age <55 years, high-grade tumors, large tumors, positive or untested lymph node status, African American or Hispanic race, and negative or unknown estrogen receptor status. Significant geographic variation was observed in the rates of RT after BCS. CONCLUSIONS: The omission of RT after BCS was more common in recent years, especially among women who had an increased risk of breast cancer recurrence. This trend represents a serious health care concern because of the potential increased risk of local recurrence and breast cancer mortality.

Racial disparities in travel time to radiotherapy facilities in the Atlanta metropolitan area

“…Studies have shown African American and Hispanic women are less likely to receive radiation therapy compared to white women. Women with lower SES and education compared to women with higher SES and education, uninsured women compare to insured women, and women having Medicaid as their health insurance compared to women with other sources of insurance are also less likely to receive radiation therapy (Foley et al, 2007;Parise, Bauer, & Caggiano, 2012;Royak-Schaler et al, 2012;Smith et al, 2010;Tuttle et al, 2012;Voti et al, 2006).…”

United States Trends in the Surgical Treatment of Primary Breast Cancer

“…In another recent study using the American College of Surgeons National Cancer Data Base, Daroui et al [36] reported the only 66.6 and 63.0% of patients with stage I and II breast cancer, respectively, received RT after BCS from 2000 to 2006. Although randomized trials have suggested that RT may be safely avoided in selected patients 70 years or older [37], recent trends suggest that RT is increasingly omitted in younger patients [38].…”

A Population-Based Observational Study of First-Course Treatment and Survival for Adolescent and Young Adult Females with Breast Cancer

“…Increases in BCS without radiation have also been observed among women of all ages in recent years. 38 Nevertheless, this result is surprising, since the importance of radiation after BCS is well accepted. 16,17 Increasing receipt of BCS without radiation over time may be driven by concerns over long-term effects of chest irradiation in young women.…”