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Radiation still used despite evidence of little benefit to some older breast cancer patients
Date:3/5/2012

Even though a large clinical study demonstrated that radiation has limited benefit in treating breast cancer in some older women, there was little change in the use of radiation among older women in the Medicare program, Yale School of Medicine researchers report in the March Journal of Clinical Oncology.

"We were surprised by these results," said lead author Cary P. Gross, M.D., associate professor of internal medicine at Yale School of Medicine. "Clinical trials are considered the gold standard of medical research and in this case the trial was influential enough to lead to a change in treatment guidelines. We expected it to have more of an impact on clinical care at the bedside."

The typical course of treatment for older women with early stage breast cancer is breast-conserving surgery followed by radiation therapy. The purpose of added radiation therapy is to reduce recurrence of the disease. However, many older women have less aggressive tumors that place them at low risk for tumor recurrence.

The Yale team studied the impact of a large research trial funded by The National Cancer Institute (NCI) on clinical practice. Published in 2004, that NCI trial found that radiation therapy had only a small benefit for some women 70 and older with early stage, low-risk breast cancer. As a result of this study, breast cancer treatment guidelines were changed to indicate that radiation therapy could be considered optional for such patients.

But in the years following implementation of the new guidelines, Gross and his colleagues found that there has been minimal impact on the clinical care of older women with breast cancer. The team looked at the use of radiation therapy among Medicare beneficiaries diagnosed with early stage breast cancer before and after the large NCI clinical trial was published. About 79% of women received radiation prior to the study compared with 75% after.

Even among the oldest women (85-94
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Contact: Karen N. Peart
203-432-1326
Yale University
Source:Eurekalert

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