Excess Radiation Used in Breast Cancer Treatment

A new study revealed that more than half of older American women who were diagnosed with early breast cancer may get more radiation therapy than they actually need, therefore increasing medical costs.

Based on data from 2011, researchers had estimated that around $164 million in costs could have been saved by ordering a shorter radiation course instead.

According to Dr. Rachel Greenup, the study leader and assistant professor of surgery at Duke University Medical Center Cancer Institute in Durham, N.C, some women who were eligible for shorter radiation courses or omission of radiation were still getting longer courses that cost them a lot more. Though, Greenup and other experts said that the results might not be applicable today anymore because a lot are now receiving shorter courses of radiation as compared in 2011.

To conduct the study, Dr. Greenup and her team of scientists used data from the U.S. National Cancer Database on 43,000 breast cancer patients aged 50 and above.

According to the researchers, 57% of women still got the traditional six-week course even if they could have avoided breast radiation or gotten the short course. These patients had small tumors that have not yet spread to their lymph nodes. They had to undergo a lumpectomy (breast-conserving surgery) followed by breast radiation to reduce the chances of the cancer coming back.

The shorter radiation courses call for higher radiation dosages delivered in fewer sessions, making it less expensive and more convenient for patients.

As mentioned by the researchers, the cost per patient for the traditional six-week course was about $13,000, and about $8,000 for the shorter course. For an entire year, the radiation costs for those who could have avoided or shortened treatment was around $420 million.

As shown in previous studies, patients who are qualified for the shorter four-week course have no bigger risk of cancer recurrence as opposed to those who are on the traditional six-week program. Also, women aged 70 and older have no extra survival benefit with the traditional six-week program compared to the women who did not undergo radiation and only taking Tamoxifen after lumpectomy.

According to Dr. Laura Kruper, co-director of the breast cancer program at City of Hope Comprehensive Cancer Center in Duarte, California, there is a possibility of decreasing the costs and burden of treatments for early stage breast cancer patients without compromising care.

However, according to the researchers, the new study also has limitations. First, the national database did not provide any details as to why doctors recommended the traditional six-week course. Second, some tumors initially might have seemed to qualify for the shorter program, but if high-risk features showed up in microscopic assessments, the longer course should’ve been preferred. Third, the cost estimates were based on data from Medicare reimbursement, which is not as all-inclusive as insurance data.

According to Dr. Rosenthal, a radiation oncologist of Sutter Medical Group in Sacramento, California, in his practice, only about 80% of patients are treated with the four-week course, meaning not everyone is a good candidate for the shorter treatment. He also added that the shorter course treatment can be rougher to some, and that is why some patients experience a stronger skin reaction to it.

When asked what the best advice for patients is, Dr, Kruper said that seeking a second opinion regarding radiation therapy is highly recommended. Do some research and go to a facility that is known for offering hypofractionated (shorter-course) therapy to the majority of eligible patients.