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Does persistent use of radiation in women > 70 years of age with early-stage breast cancer reflect tailored patient-centered care?

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Randomized controlled trials demonstrate that omission of radiation therapy (RT) in older women with early-stage cancer undergoing breast conserving surgery (BCS) is an “acceptable choice.” Despite this, high RT rates have been reported. The objective was to evaluate the impact of patient- and system-level factors on RT rates in a contemporary cohort.

Methods

Through the National Cancer Data Base, we identified women with clinical stage I estrogen receptor-positive breast cancer who underwent BCS (n = 84,214). Multivariable logistic regression identified patient, tumor, and system-level factors associated with RT. Joinpoint regression analysis calculated trends in RT use over time stratified by age and facility-type, reporting annual percent change (APC).

Results

RT rates decreased from 2004 (77.2%) to 2015 (64.3%). The decline occurred earliest and was most pronounced in older women treated at academic facilities. At academic facilities, the APC was − 5.6 (95% CI − 8.6, − 2.4) after 2009 for women aged > 85 years, − 6.4 (95% CI − 9.0, − 3.8) after 2010 for women aged 80 −  < 85 years, − 3.7 (95% CI − 5.6, − 1.9) after 2009 for women aged 75 −  < 80, and − 2.4 (95% CI, − 3.1, − 1.6) after 2009 for women aged 70 −  < 75. In contrast, at community facilities rates of RT declined later (2011, 2012, and 2013 for age groups 70–74, 75–79, and 80–84 years).

Conclusions

RT rates for older women with early-stage breast cancer are declining with patient-level variation based on factors related to life expectancy and locoregional recurrence. Facility-level variation suggests opportunities to improve care delivery by focusing on barriers to de-implementation of routine use of RT.

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Funding

Dr. Taylor is supported by a training award from the National Institutes of Health (T32CA090217). Dr. Neuman received support from the BIRCWH Scholars Program (K12 HD055894).

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Authors and Affiliations

  1. Department of Surgery, University of Wisconsin, Madison, WI, USA

    Lauren J. Taylor, Jessica R. Schumacher, Lee G. Wilke, Caprice C. Greenberg & Heather B. Neuman

  2. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Jennifer S. Steiman

  3. Department of Human Oncology, University of Wisconsin, Madison, WI, USA

    Bethany Anderson

  4. Carbone Cancer Center, University of Wisconsin, Madison, WI, USA

    Bethany Anderson, Lee G. Wilke, Caprice C. Greenberg & Heather B. Neuman

  5. Clinical Science Center, 600 Highland Avenue, K6/142, Box 7375, Madison, WI, 53792, USA

    Heather B. Neuman

Authors
  1. Lauren J. Taylor
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  2. Jennifer S. Steiman
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  3. Bethany Anderson
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  4. Jessica R. Schumacher
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  5. Lee G. Wilke
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  7. Heather B. Neuman
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Correspondence to Heather B. Neuman.

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Conflict of interest

Lee Wilke is a minority stock owner and founder of Elucent Medical. Caprice Greenberg is a consultant for Johnson & Johnson.

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This project is considered to be exempt by the University of Wisconsin Institutional Review Board.

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Taylor, L.J., Steiman, J.S., Anderson, B. et al. Does persistent use of radiation in women > 70 years of age with early-stage breast cancer reflect tailored patient-centered care?. Breast Cancer Res Treat 180, 801–807 (2020). https://doi.org/10.1007/s10549-020-05579-5

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  • DOI: https://doi.org/10.1007/s10549-020-05579-5

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