Despite deterrents, older women still getting radiation therapy after lumpectomy

Radiation therapy for post-lumpectomy patients 70 and older with small, hormone receptor-positive breast cancer should have significantly declined over the past 16 years, but it’s only dipped a bit.

2004 was the year the Cancer and Leukemia Group B (CALGB) 9343 trial showed radiation treatments after surgery could be safely skipped for this population. Guidelines recommending the omission soon followed from the National Comprehensive Cancer Network.

In spite of the momentum, the pullback has totaled less than 3 percent, according to a study published in the January Journal of the American College of Surgeons.

Quyen D. Chu, MD, MBA, and colleagues at Louisiana State University arrived at the finding by pulling from the National Cancer Data Base the cases of 205,860 women 70 and up who had lumpectomy after being diagnosed between 1998 and 2012 with stage I, estrogen/progesterone receptor-positive breast cancer.

The team discovered that, in the post-CALGB group, radiation therapy utilization after lumpectomy decreased by just 2.95 percent (68.71 percent before vs. 65.76 percent after).

There was significant variation across geographic and sociodemographic groupings, but, overall, even women with short life expectancy, those 85 and older, received the radiation to the tune of one-third of the post-CALGB group.

Also, socioeconomic factors such as insurance status and education level had no bearing on treatment rates.

“Whether radiation therapy should be omitted in this select group of breast cancer patients, especially among extremely elderly women, will require analysis of a large population-based database,” the authors write in their discussion. “Such analysis will help answer the question of whether or not results of randomized controlled trials such as CALGB and PRIME II are also observed in the general population.”