Despite alternatives, women still undergo longer courses of breast cancer rad therapy

Most women who are treated for early-stage breast cancer in the U.S. undergo a course of radiation therapy that is much longer than a less time consuming version of the treatment that oncologists believe is just as effective.

This shorter course of radiation treatment--which involves administering higher doses of radiation over a three-week period rather than a lower dose over a five-to-seven week period--was approved by the American Society for Radiation Oncology (ASTRO), in 2011, with the understanding that the shorter protocol was just as effective for women who are over the age of 50 and have not undergone chemotherapy.

But in a study published last week in the Journal of the American Medical Association, researchers from the University of Pennsylvania Perelman School of Medicine found that the majority of women who undergo lumpectomies are still receiving the longer radiation course.

The shorter radiation course--called hypofractionated whole breast radiation--"is infrequently used for women with early-stage breast cancer, even though it's high-quality, patient-centric cancer care at lower cost," lead author Justin Bekelman, an assistant professor of radiation oncology, medical ethics and health policy at Perelman, said in a announcement. "It is clinically equivalent to longer duration radiation in curing breast cancer, has similar side effects, is more convenient for patients, and allows patients to return to work or home sooner."

According to the study, in 2013, 34.5 percent of women over 50 years of age received hypofractionated radiation therapy, up from 10.6 percent in 2008, while among younger women and those with advanced cancers, 21 percent underwent hypofractionated radiation therapy in 2013, compared to 8.1 percent in 2008.

"Hypofractionated radiation is high-value care and high-quality breast cancer treatment that saves the health care system money. It's a win-win. And yet, only a third or fewer women are getting it in the U.S., while in other countries over 70 percent of women receive hypofractionated treatment," said senior author Ezekiel Emanuel, chairman of Penn's Department of Medical Ethics and Health Policy and a breast oncologist.

According to research presented last spring at the American Roentgen Ray Society's annual meeting in San Diego, women significantly overestimate the amount of radiation associated with mammography--a situation that could dissuade them from undergoing screening.

To learn more:
- see the study published in JAMA
- see the announcement