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Physicians’ Views on Radiotherapy for Older Women With Early-Stage Breast Cancer

By: Andrew Goldstein
Posted: Tuesday, November 7, 2017

Many physicians continue to recommend adjuvant radiotherapy following lumpectomy to older women with stage 1, estrogen receptor–positive breast cancer, despite studies showing little significant benefit of the procedure. Dean A. Shumway, MD, of the Department of Radiation Oncology at the University of Michigan, and colleagues conducted a national survey of radiation oncologists and surgeons and published their findings in the Annals of Surgical Oncology.

“[Two recent prospective clinical trials] showed that whether or not older women with small tumors receive radiation, they live the same amount of time,” revealed Dr. Shumway in a University of Michigan press release. “Radiation does not appear to prolong survival.”

Of the 825 physicians (452 surgeons, 373 radiation oncologists) who responded to the survey, just 40% of surgeons and 20% of radiation oncologists considered omission of radiotherapy after lumpectomy to be reasonable for women over the age of 70. One-third of both surgeons and radiation oncologists wrote that they would recommended radiotherapy for an 81-year-old with multiple comorbidities.

Two studies of older women with stage 1, estrogen receptor–positive breast cancer found that local tumor control improvement was modest when lumpectomy was followed by radiotherapy. One study followed women over 70 for 10 years, and the second followed women 65 and older for 5 years. These studies demonstrated that receiving endocrine therapy without radiotherapy achieved similar results.