It s not uncommon for women with breast cancer to receive radiation therapy to prevent relapse, but is this modality beneficial for older women with early-stage breast cancer? Current National Comprehensive Cancer Network guidelines say opting out of radiation in these patients is okay a recommendation that was issued in 2005, based on a 2004 study that showed radiation therapy following breast-conserving surgery didn t improve survival in older patients with stage I breast cancer.
A new study led by researchers from the Yale School of Medicine sought to determine whether these guidelines actually affected clinical practice. Published in the Journal of Clinical Oncology, lead author Dr. Cary Gross and his colleagues analyzed data from nearly 13,000 stage 1 breast cancer patients aged 70 and older from 2001 to 2007. Almost 77 percent of these women received radiation in addition to breast conserving surgery, and that number barely decreased after the guidelines were changed. In addition, of women who were expected to live less than five years, 44 percent received radiation therapy prior to the 2004 study, and 41 percent after demonstrating that the guidelines had little to no impact on patient care.
Dr. Gross and his team also tracked down the same women from the original 2004 study ten years after their treatment, and found no difference in mortality between women who received radiation and those who did not. As Dr. Gross points out, even after guidelines change, doctors may continue to treat older patients with radiation in order to feel that they re doing everything they can to care for their patients.
But this should not be acceptable practice, says ACSH's Dr. Gilbert Ross. The benefits of radiation in this cohort are not there, he says, so this therapy should not be administered as freely as seems to be the case now. Not to mention that there are side effects associated with radiation, as well as the inconvenience of actually traveling to these appointments, and the not-insignificant cost around $7,000.
