FORCE’s eXamining the Relevance of Articles for Young Survivors (XRAYS) program is a reliable resource for breast cancer research-related news and information. XRAYS reviews new breast cancer research, provides plain-language summaries, and rates how the media covered the topic. XRAYS is funded by the CDC.
Breast cancer survivors
Women under 45
Women over 45
Men with breast cancer
Metastatic breast cancer
Triple negative breast cancer
BRCA mutation carriers
Her2+ breast cancer
Special populations: women with early-stage breast cancer who undergo lumpectomy
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)
Potential health care cost savings if early-stage breast cancer patients received the least expensive radiation regimen for which they were safely eligible.
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.
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.
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.
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.
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?
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:
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.
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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.
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