Early Estrogen Receptor–Positive Breast Cancer: Are Older Women Being Overtreated?
Posted: Tuesday, July 27, 2021
To the potential detriment of women 70 years and older being treated for early-stage, estrogen receptor–positive, node-negative breast cancer, certain national guidelines are not being followed closely enough, according to the results published in JAMA Network Open of a large single-center cohort study. The high usage rates of both sentinel lymph node biopsy and adjuvant radiotherapy do not appear to be following Choosing Wisely and National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology, respectively, wrote Priscilla F. McAuliffe, MD, PhD, of UPMC Hillman Cancer Center, Pittsburgh, and colleagues.
“This study [exemplifies] how we can use big data to deliver on the promise of precision medicine—getting the right treatment to the right patient at the right time,” said coauthor Adrian V. Lee, PhD, also of UPMC, in a press release. “Sometimes—as it happens to be in this case—that could mean deciding not to provide a certain treatment to ensure better care for the patient.”
Women in this population who underwent sentinel lymph node biopsy and adjuvant radiotherapy did not experience better 5-year locoregional recurrence–free survival or disease-free survival than those who did not, noted the researchers. The analysis initially included 3,361 women (median age, 77 years) with this particular breast cancer profile treated between 2010 and 2018 at 15 hospitals within the University of Pittsburgh health system. Of them, 2,195 (65.3%) underwent sentinel lymph node biopsy, and 1,828 (54.4%) received adjuvant radiotherapy. Then, the team limited its analysis to 2,109 patients treated between 2010 to 2014 (median follow-up, 4.1 years).
Overall, the group experienced low absolute rates of recurrence: 3.5% and 4.5% in the women who did and did not undergo sentinel lymph node biopsy, respectively, and 2.7% and 5.5% in those who did and did not receive adjuvant radiotherapy, respectively. “In the propensity score–matched cohorts, no association was found between sentinel lymph node biopsy and either locoregional recurrence–free survival or disease-free survival…, and adjuvant radiotherapy was not associated with locoregional recurrence–free survival or disease-free survival,” noted Dr. McAuliffe and colleagues.
Disclosure: The study authors’ disclosure information can be found at jamanetwork.com.
