Get Critical Health Info

Making Sense of Cancer Headlines

FORCE's XRAYS program, funded by the CDC, is a reliable resource for young breast cancer survivors and high-risk women to navigate through breast cancer research related news and information.

XRAYS logo and women

Cost savings associated with a shorter course or omission of radiation treatment for early-stage breast cancer


This research is relevant for:

Checked Breast cancer survivors

Checked Women under 45

Checked Women over 45

Unhecked Men with breast cancer

Unhecked Metastatic breast cancer

Unhecked Triple negative breast cancer

Unhecked Previvors

Unhecked BRCA mutation carriers

Unhecked ER/PR +

Unhecked Her2+ breast cancer

Checked Special populations: women with early-stage breast cancer who undergo lumpectomy

Be a part of XRAYS

XRAYS:  Making Sense of Cancer Headlines

Breast cancer treatment costs are high. Lumpectomy followed by radiation therapy is a common treatment for early-stage breast cancer; however, patients may receive different radiation regimens, which carry different costs. Authors of this research study wanted to estimate the potential health care cost savings if early-stage breast cancer patients received the least expensive radiation regimen for which they were safely eligible. (6/20/17)


STUDY AT A GLANCE

This study is about:

Potential health care cost savings if early-stage breast cancer patients received the least expensive radiation regimen for which they were safely eligible.

Why is this study important?

According to the study authors, “Breast cancer treatment costs are the highest among all cancer types, estimated to reach $20 billion by 2020.” While patients and their healthcare providers should work together to determine the most effective treatment plan, high-quality cost-effective treatments are increasingly needed. 

For patients with early-stage breast cancer, who do not carry a BRCA, PALB2, ATM, CHEK2 or other genetic mutation associated with increased breast cancer risk, lumpectomy is often the preferred surgical treatment option. Lumpectomy is often followed by radiation therapy (RT), a type of cancer treatment that uses beams of energy to kill cancer cells. Whole breast irradiation (WBI) is recommended for most women after lumpectomy as it has been shown to reduce local recurrence and improve overall survival. Currently there are two standard-of-care radiation therapy regimens following lumpectomy

  • Conventional Whole Breast Irradiation (C-WBI), consists of 5 to 7 weeks of daily radiation treatments.
  • Hypofractionated WBI (HF-WBI) involves delivering a higher dose of radiation over a shorter period of time of about 3 weeks.

HF-WBI is considered less costly than C-WBI. As recently as 2014, patients were commonly treated with the conventional 5-7 week radiation therapy. However, several randomized trials have confirmed that patients treated with the shorter, HF-WBI have similar disease-free and overall survival rates as those treated with CF-WBI. The American Society for Radiation Oncology (ASTRO) and other professional groups have issued guidelines for use of HF-WBI in patients: women with small (≤3 cm), node-negative breast cancers with negative surgical margins, patients who are at least 50 years old, and patients who have non-invasive disease.

Study findings: 

  1. About 57% of early-stage breast cancer patients in 2011 were safely eligible for a shorter radiation treatment or no radiation treatment compared to the radiation treatment that they received.
  2. The study authors estimated that if these breast cancer patients had received the least expensive radiation treatment for which they were safely eligible, estimated savings would have been almost $170 million.

What does this mean for me?

This study received a "Medium" relevance score because the results do not necessarily impact the medical decisions of women diagnosed with breast cancer today.

The research presented in the studies covered in this XRAYS suggests that costs for radiation therapy to treat early-stage breast cancer in 2011 would have been significantly less if patients would have received the least expensive radiation regimen for which they were safely eligible. The authors concluded that, “A majority of women in the United States are receiving longer and more costly adjuvant radiation treatment than current data deem medically necessary.”

While this study is interesting, even the authors noted that treatment decisions are complex and based on many factors that were not considered in this study. It is possible that the women who looked like they were eligible for less radiation on paper actually needed a higher dose based on their specific anatomy or other factors found on physical exam.  Finally, this study looked at patient data from 2011.  When considering RT patients should discuss with their health care provider current recommendations.  Careful consideration of a radiation treatment regimen must be made by a patient and her care team.

Questions to ask your health care provider:

  • Do I need radiation treatment?
  • What are my radiation treatment options?
  • How do I decide which radiation treatment is best for me?

IN-DEPTH REVIEW OF RESEARCH

Study background:

Previous work suggested that radiation regimens with fewer treatments and higher radiation amounts were safe. Patients who received whole-breast irradiation consisting of 42.5 Gy (Gray or Gy is a measure of the dose of irradiation or the amount of energy being transferred) in 16 treatments over 22 days had similar survival rates compared to patients who received traditional whole breast irradiation consisting of 50 Gy in 25 treatments over 35 days. Additionally, some clinical trial data suggests that some carefully selected patients may avoid radiation treatment entirely after lumpectomy.

As recently as 2014 patients were commonly treated with the conventional 5-7 week radiation therapy. The American Society for Radiation Oncology (ASTRO) and other professional groups have issued guidelines for use of HF-WBI in patients: women with small (≤3 cm), node-negative breast cancers with negative surgical margins, patients who are at least 50 years old, and patients who have non-invasive disease.

The choice of radiation treatment, as well as identification of patients who can be managed without radiation, can impact health care spending. Rachel Greenup and colleagues from Duke University Medical Center and other institutions published work in the Journal of Oncology Practice to estimate cost savings if early-stage breast cancer patients received the least costly radiation treatment for which they were safely eligible based on the criteria in this study. It is important to remember that for individual patients, the criteria is complex and must be made between the patient and her care team. Furthermore, recurrence rates with different types of radiation therapy should be carefully considered.

Researchers of this study wanted to know:

What are the potential health care cost savings if early-stage breast cancer patients received the least expensive radiation regimen for which they were safely eligible?

Population(s) looked at in the study:

This study analyzed data from the American College of Surgeons National Cancer Database (NCDB).  Women who had node-negative, early-stage invasive breast cancers and were treated with lumpectomy during 2011 were the study group because of the availability of cost data. Cost data for the following radiation treatment regimens was collected:

  • Lumpectomy and conventionally fractionated whole-breast external-beam irradiation (CF-WBI) or traditional RT (27,697 women; 64%)
    • Estimated radiation cost $13,358
  • Lumpectomy and hypofractionated whole-breast irradiation (HF-WBI) (5724 women; 13%)
    • Estimated radiation cost $8,328
  • Lumpectomy without radiation treatment (9,349 women; 21.6%)
    • Estimated radiation cost $0

Study findings: 

  1. About 57% of early-stage breast cancer patients in 2011 were safely eligible for a shorter radiation treatment or no radiation treatment compared to the treatment that they received.
  2. The study authors concluded that if these patients had received the least expensive radiation regimens that they were safely eligible for, estimated costs would have been $252.2 million compared to the $420.2 million that was spent in 2011 for a cost savings of almost $170 million.

Limitations:

  • One of the biggest limitations of this study is that it generalizes breast cancer patient care without considering specific individual issues. Regardless of the results of this study, the final treatment decision should be made by a patient and her health care providers. 
  • This study used data from 2011 and radiation treatment regimens have changed. It is likely that today more patients are being offered a shorter course of radiation for treatment of early breast cancer.
  • In addition, this was a retrospective study, meaning the authors used data from previously documented records of past patients instead of collecting patient data specifically for this study. This means that other factors that were unknown to the study authors may have affected the results. 
  • Additionally, the authors were unable to estimate the costs of breast cancer recurrence when comparing the different radiation treatment regimens because the database they used did not include recurrence rates or data on treatment after recurrence.
  • Finally, the study authors stated that “It is important to acknowledge the risk of perceived overtreatment within this study when women may have in fact received appropriate care. Clinical decisions made by the treating team are often based on patient factors and features of the disease that are not captured within large national databases…”                     

Conclusions:

This study suggests that health care costs associated with radiation treatment could be reduced if patients received the least expensive radiation regimen for which they were safely eligible. However, this study does not capture all the factors that go into a treatment decision. Individuals who are genetically predisposed to breast cancer should know that recurrence rates are higher for mutation carriers who undergo lumpectomy and radiation therapy. Women should continue to work with their health care providers to determine the treatment that is best for them.

Share your thoughts on this XRAYS article by taking our brief survey

Posted 6/20/17

References

Greenup RA, Blitzblau RC, Houck KL, et al. “Cost implications of an evidence-based approach to radiation treatment after lumpectomy for early-stage breast cancer.” Journal of Oncology Practice. Published online first on March 14, 2017.

Kyung Su Kim, MD, Kyung Hwan Shin, MD, PhD, Noorie Choi, MD, and Sea-Won Lee, MD., "Hypofractionated whole breast irradiation: new standard in early breast cancer after breast-conserving surgery." Radiat Oncol J. 2016 Jun; 34(2): 81–87.

 

Related Information and Resources

Breast Cancer Treatment:  Surgery and radiation for breast cancer

Breast Cancer Survivors: Hereditary breast cancer treatment

Be Empowered Webinar: Newly Diagnosed with Breast Cancer, What You Need to Know

Back to XRAYS Home

Find older XRAYS studies and articles

By keyword search:

By date range:

By quarterly digest:

FORCE:Facing Our Risk of Cancer Empowered