Recommended Radiation Omitted From Breast Conservation Therapy for Some Women

Nearly 10% of eligible women in a recent study did not receive radiation therapy after breast conservation surgery, although it is proven to reduce the risk of recurrence. The researchers, from Fox Chase Cancer Center and the Lewis Katz School of Medicine at Temple University, also sought factors that led to omission of radiation in these women. Richard Bleicher, MD, a surgical oncologist at Fox Chase, is senior author of the study, which appears in the Journal of Surgical Research.

The researchers analyzed data from the National Cancer Database to examine the course of treatment for more than 10,000 women with unilateral breast cancer that was Stage 2 or 3 at diagnosis. All women in the study received a combination of neoadjuvant (preoperative) chemotherapy and breast conservation surgery between 2008 and 2012. They found that 9.53% of the women who were eligible for radiation after the surgery did not receive it.

"Although neoadjuvant chemotherapy can be used to shrink tumors prior to surgery, radiation after breast conservation surgery remains standard of care, and preoperative chemotherapy doesn't eliminate the need for it. Radiation is still critical in reducing the rate of recurrence in women who undergo breast conservation therapy," Bleicher says. "We found that 3% of these women refused the radiotherapy, but we need to understand why the other 6% did not even have it recommended. Since all of these women had chemotherapy, an inability to tolerate the radiation may not be the primary reason."

The study found that older age, insurance status, the facility type where the patient received treatment, geographic region, and more recent year of diagnosis were factors that led to omission of radiation as part of breast conservation therapy. The researchers were able to determine that race, education, income, comorbidities, rural vs urban setting, and tumor histology were not among the reasons women did not receive radiation.

Source: Fox Chase Cancer Center